婴幼儿喘息急性期联合降阶梯治疗方案中孟鲁司特钠的作用研究

Effect of Montelukast in the Combined De-escalation Therapy for Infantile Acute Wheezing

目的:探讨婴幼儿喘息急性期联合降阶梯治疗方案中孟鲁司特钠的作用。方法:选取2012年5-9月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85例,随机分为试验组和对照组。试验组44例,实际完成随访31例;对照组41例,实际完成随访32例。试验组使用孟鲁司特钠4 mg/d,疗程14 d,其他药物治疗包括:口服泼尼松0.5 mg/(kg.d),疗程3 d;口服阿奇霉素10 mg/(kg.d),疗程3 d;每晚使用妥洛特罗贴剂1贴(0.5 mg/d),疗程7 d;氯雷他定0.3 mL/(kg.d),疗程14 d。对照组未用孟鲁司特钠,其他药物治疗同试验组。分别在开始治疗后第3天、第7天、第14天、第21天、第28天进行随访,分析疗效。结果:(1)两组患儿咳嗽、喘息、哮鸣音、鼻塞症状评分在第3天、第7天、第14天比较差异均有统计学意义(P<0.05);(2)痰鸣音及鼻涕症状评分第3天、第7天比较差异有统计学意义(P<0.05),第14天、第21天、第28天比较差异无统计学意义(P>0.05);(3)喷嚏症状评分仅在第3天比较差异有统计学意义(P<0.05);(4)两组自觉症状完全缓解天数比较差异无统计学意义(P>0.05)。结论:婴幼儿喘息急性期联合降阶梯治疗方案中,孟鲁司特钠虽不能明显缩短病程,但可更有效地缓解喘息症状,是婴幼儿喘息急性期联合降阶梯方案的有效组分之一。

Objective： To evaluate the efficacy of montelukast in the combined de-escalation therapy for infantile acute wheezing.Methods： Eighty-five outpatients from May 2012 to September 2012 were randomly divided into two groups： the montelukast group and the control group.Thirty one cases of the montelukast group and 31 cases of the contro group completed the study.The montelukast group received montelukast 4 mg/d for fourteen days,oral prednisone 0.5 mg/（kg·d） for three days,azithromycin 10 mg/（kg·d） for three days,tulobuterol patch（0.5 mg/d） for seven days and loratadine 0.3 mL/（kg·d） for fourteen days.Montelukast was abolished in the control group,the rest of therapy was the same as the montelukast group.Results： The respiratory symptoms（cough,asthma and wheezing rale） and the nasal symptoms（nasal congestion,sneezing and runny nose） in the acute phase of the two groups were improved after treatment（P0.05）.Cough,wheezing and nasal congestion on the 3rd,7th,14th day of the treatment between the two groups were statistically different（P0.05）.The sneezing and phlegm rale were statistically different（P0.05） only on the 3rd and 7th day of the treatment.The clinical course of the two groups had no significant difference.Conclusions：In the combined de-escalation therapy,montelukast can obviously improve the wheezing,cough and nasal symptoms in infantile acute wheezing.According to our research,montelukast should be chosen as one of the main medication of the combined de-escalation therapy.