婴幼儿喘息急性期联合降阶梯治疗方案中氯雷他定的作用

Effect of Loratadine combined with de-escalation therapy for wheeze in infants

目的探讨联合降阶梯方案中口服氯雷他定在治疗婴幼儿喘息急性期中的作用。方法将2011年12月至2012年4月在上海交通大学医学院附属新华医院哮喘专科门诊就诊的婴幼儿喘息患儿100例作为研究对象，随机分为氯雷他定组和对照组，2组具有可比性。氯雷他定组选用氯雷他定0．3mL／（kg·d），疗程14d。其他药物包括口服泼尼松0．5mg／（kg·d），疗程3d；口服阿奇霉素10mg／（kg·d），疗程3d；每晚使用妥洛特罗贴剂1贴（0．5mg／d），疗程7d；口服孟鲁司特钠4mg／d，疗程14d。对照组未用氯雷他定，其余用药剂量及方法同氯雷他定组。分别在第3、7、14天和1个月进行随访，分析患儿的治疗效果。结果1．治疗后，氯雷他定组和对照组婴幼儿喘息急性期的呼吸道症状（喘息、哮鸣音、排痰难易）和鼻部症状（鼻塞、喷嚏、流涕）均有缓解，治疗前后评分比较差异均有统计学意义（P均〈0．05）。2．氯雷他定组和对照组在咳嗽症状的评分上差异有统计学意义（P〈0．05）；除喷嚏、咳嗽外其余各项症状评分在治疗第3、7和14天差异均无统计学意义（P均〉0．05）。3．在湿疹症状评分方面，氯雷他定组和对照组在治疗第3天与治疗前比较差异均无统计学意义（P均〉0．05），但氯雷他定组在治疗第7天和第14天与治疗前比较差异有统计学意义（P均〈0．05），对照组仍无明显差异。4．氯雷他定组和对照组症状好转天数、1个月喘息复发次数和1月内呼吸道感染次数比较差异均无统计学意义（P均〉0．05）。结论在联合降阶梯方案治疗婴幼儿喘息中，氯雷他定能明显改善患儿的咳嗽症状，对湿疹有治疗作用，安全性高。在联合降阶梯方案治疗婴幼儿喘息急性期中可根据病情个体化选用氯雷他定。

Objective To evaluate the efficacy of loratadine combined with de-escalation therapy for infant wheeze. Methods One hundred out-patients from Dee. 2011 to Apr. 2012 were randomly divided into 2 groups ： Loratadine combined with de-escalation therapy was adopted in Loratadine group, while no Loratadine was taken in control group. The dose of Loratadine was 0.3 mL/（ kg · d） ,14 days; oral Prednisone 0.5 mg/（ kg · d） ,3 days; Azithromycin 10 mg/（ kg · d） ,3 days; Tulobuterol patch 0.5 mg/d,7 days; Montelukast 4 mg/d, 14 days. Control group abolished Loratadine, but the rest of drugs were same as Loratadine group. Results The respiratory symptoms （gasp, wheeze sound, phlegm removal difficulty） and the nasal symptoms （including nasal congestion, sneeze, runny nose） in the acute phase of infant wheeze all had therapeutic effect, and there were significant differences in scoring symp- toms （all P 〈 0.05 ）. The Loratadine group had certain treatment effect on eczema. The cough symptoms in 3 days, 7 days, 14 days of the treatment had statistically significant differences between the both groups （ all P 〈 0.05 ）. And there were statistical differences in eczema symptom of the Loratadine group in 7 days and 14 days of treatment （ all P 〈 0.05 ）. Control group still had no statistical differences （ all P 〉 0.05 ）. Days of improvement in symptoms, wheeze recurrence rate and frequency of respiratory infections in 1 month between 2 groups had no significant differences. Conclusions Loratadine can obviously improve the patients＇ breathing cough symptoms, and play a certain role in the treatment combined with de-escalation therapy in infant wheezing, and has high safety and eczema therapy effect. Loratadine can be used in clinic personally according to the patient＇s condition.