激素联合支气管舒张剂雾化吸入治疗哮喘中重度急性发作疗效评价

Effects of inhalation therapy in the management of moderate to severe acute asthma exacerbations

目的:比较单纯吸入药物,包括吸入性糖皮质激素(inhaled corticosteroid,ICS)和支气管舒张剂与上述吸入疗法联合全身糖皮质激素(systemic corticosteroid,SC)在治疗中重度支气管哮喘急性发作中的疗效差异。方法:69例确诊的支气管哮喘中重度急性发作患者,分为单纯吸入药物治疗组(A组,n=23)、联合吸入药物和静脉滴注甲基强的松龙组(B组,n=46)。比较两组在症状好转、消失时间,哮鸣音好转、消失时间和住院时间方面的差异;另外还比较两组在治疗失败率方面的差异。结果:支气管哮喘中重度急性发作患者,除哮鸣音消失时间以B组更短以外(P<0.05),在症状好转、症状消失和哮鸣音好转以及住院时间方面均无显著性差异(P>0.05)。但在治疗失败率方面,A组显著高于B组(P<0.05)。结论:中重度哮喘急性发作患者,联合使用吸入激素、支气管舒张剂及SC的疗效优于单纯吸入激素和解痉平喘药物。ICS和支气管舒张剂吸入不能作为治疗中重度哮喘急性发作的主要缓解用药。

Objective： To evaluate the effectiveness of inhalation therapy in the management of moderate to severe acute asthma exacerbations.Methods： Data of 69 cases of diagnosed asthmatic patients were reviewed.The degree of these acute asthmatic exacerbations meets the definition of moderate to severe onset.Among these patients some were treated by inhaled corticosteroid（ICS） and inhaled bronchodilator only（group A,n=23） and others were treated by inhalation therapy combined with systemic corticosteroid（SC）（group B,n=46）.The time from admission to symptom improvement,wheeze abatement,disappearance of symptoms and wheezing sound and length of hospital stay were compared between group A and B.The failure rate of treatment of each group was also compared.Results： In moderate to severe asthmatic patients,except the duration of wheezing sound in combination therapy is shorter than inhalation therapy（P〈0.05）,comparison of all other parameters draws no significant differences（P〈0.05）.However,inhalation therapy had more failed cases than combination therapy（P〈0.05）.Conclusion： In treating moderate to severe acute asthmatic patients,inhalation therapy is not as effective as combination therapy in controlling symptoms so that the role of SC could not be substituted by inhaled medications in these circumstances.