静脉用大剂量丙种球蛋白联合布地奈德、异丙托溴铵治疗重症毛细支气管炎的临床研究

Clinical Study of Intravenous High Dose of Gamma Globulin Combined with Budesonide,Ipratropium Bromide in Treatment of Severe Bronchiolitis

目的:探讨静脉用大剂量丙种球蛋白联合应用布地奈德、异丙托溴铵雾化吸入用于重症毛细支气管炎患者的治疗效果。方法:选取重症毛细支气管炎患儿120例并将其随机分为观察组和对照组,对照组采用常规治疗,即予糖皮质激素治疗、抗病毒、吸氧等常规对症治疗方法;观察组在对症治疗的基础上采用大剂量静脉用丙种球蛋白静滴,同时联合应用布地奈德、异丙托溴铵雾化吸入的治疗方法。经治疗5 d后,观察和比较两组患者喘息、哮鸣音减轻或消失情况及治疗后症状体征消失时间。结果:治疗5 d后,观察组显效率和有效率分别为56.5%和95.0%;明显高于对照组的41.7%和78.3%(P<0.01)。观察组呼吸困难、咳嗽、喘息、哮鸣音、痰鸣音等消失时间与对照组比较差异有统计学意义(P<0.01)。结论:大剂量丙种球蛋白静脉滴注联合布地奈德、异丙托溴铵雾化吸入治疗重症毛细支气管炎能从多角度、多渠道抑制免疫反应,减少趋化因子和细胞介质的释放,舒张支气管平滑肌,改善肺功能,提高机体非特异性免疫力,疗效确切,是一种安全有效的治疗方法。

Objective： To study effect of intravenous high dose of gamma globulin combined with budesonide, ipratropium bromide inhalation in treatment of severe bronchiolitis. Method： 120 eases of severe bronehiolitis were randomly divided into observation group and control group, the control group was treated with the con,~entional treatment, namely to glucocorticold treatment, antivlral, oxygen conventional symptomatic treatment. The observation group was treated with the high dose intravenous immunoglobulin for intravenous drip, combined application budesonide, ipratropium bromide aerosol inhalation treatment on the basis of symptomatic treatment. After treatment of 5 d, the time of asthma, wheeze relieved or disappeared and the symptoms disappeared of two groups were observed and compared. Result： After treatment of 5 d, significant efficiency and effectiveness in observation group were 56.5% and 95.0% respectively, and were higher than 41.7% and 78.3% in the control group （ P〈0.01 ） . The time of dyspnea, cough, wheezing, wheezing, sputum toot sound disappear showed a significant difference between the two groups （P〈0.01） . Conclusion： High dose of intravenous gamma globulin combined with budesonide, ipratropium bromide aerosol inhalation in the treatment of severe bronchiolitis can inhibit the immune response from the multi angle, multi channels, reduce chemokine and cytokine release, relax bronchial smooth muscle, improve lung function, improve the non-specific immunity, it is a kind of safe and effective treatment method.