哮喘轻中度发作联合降阶梯治疗方案中地氯雷他定作用研究

Clinical effect of desloratadine in the combine-counter gradient therapy for mild to moderate pediatric asthma

目的探讨联合降阶梯治疗方案组分之一地氯雷他定在急性期儿童哮喘治疗中的作用。方法将2012年9月至2012年11月上海交通大学医学院附属新华医院哮喘专科门诊诊断为支气管哮喘急性发作的120例患儿作为研究对象,用Excel生成随机数法随机分为联合方案地氯雷他定组(观察组)和联合方案无地氯雷他定组(对照组)。观察组中3～5岁患儿予地氯雷他定1.25 mg/d;>5岁患儿予2.5 mg/d治疗,疗程7d。两组其他相同治疗包括口服泼尼松0.5mg/(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(1 mg/d),疗程7 d;口服孟鲁司特钠4 mg/d,疗程7 d。1周后进行随访,分析两组方案对患儿急性期的治疗效果。结果 (1)观察组和对照组对患儿哮喘急性发作期的呼吸道症状(咳嗽、喘息、哮鸣音)和鼻部症状(鼻塞、鼻痒、喷嚏、流涕)均有治疗效果,评分差异有统计学意义(P<0.05)。(2)治疗后观察组咳嗽、喘息、哮鸣音的评分均低于对照组,但差异无统计学意义(P>0.05)。(3)观察组患儿治疗前后肺功能多项指标改善,差异有统计学意义(P<0.05),对照组治疗前后肺功能指标变化差异无统计学意义(P>0.05)。(4)观察组和对照组治疗前后呼出气一氧化氮(eNO)均有下降,但差异无统计学意义(P>0.05)。治疗7d后eNO值的组间比较差异也无统计学意义(P>0.05)。结论联合降阶梯方案能够有效控制儿童哮喘急性发作期的呼吸道症状,其中地氯雷他定能促进合并过敏性鼻炎的哮喘患儿鼻部症状的改善和肺功能的提高。

Objective To evaluate the clinical efficacy of desloratadine in the combine-counter gradient therapy for asthma children who was in acute exacerbation. Methods Take 120 cases of bronchial asthmatic children who had re- sorted asthma specialist in our hospital during September 2012 to November 2012 as research subjects;devide them ran- domly into desloratadine group （test group） , in which combine-counter gradient therapy was given, and the control group accepting combine-counter gradient therapy without desloratadine （control group）, and the two groups proved to be comparable. The treatment protocol of test group was desloratadine 1.25 mg/d （3-5 yrs old） or 2.5 mg/d （ 〉 5 yrs old）, 7 days; oral prednisone 0.5 mg/（kg-d）, 3 days; azithro- mycin 10 mg/（kg-d）, 3 days; tulobuterol patch （0.5 mg/d）, 7 days; montelukast 4 mg/d, 14 days. In the control group the drugs were the same as in test group except desloratadine. Analyze the efficacy of treatment protocols after a week. Results （1） In the test group and the control group for respiratory symptoms （cough, wheeze, wheezing sound） and the nasal symptoms （including rhinocnesmus, nasal pruritus, sneezing, runny nose） in the acute exacerbations of asthmatic children all improved with statistical sig- nificance （P 〈 0.05）. （2） The scores of respiratory sysmptoms （cough, wheeze and wheezing sound） for the test group were lower than those of the control group, yet there was no statistically significant difference （P 〉 0.05）. （3）Takingdesloratadin during the acute exacerbation could signifi- cantly improve lung function. （4） The eNO level of both group have obvious decline, yet there was no statistically significant difference （P 〉 0.05）. The eNO level also had no statistically significant difference between the twogroups. Conclusion The combine-counter gradient therapy has obvious effect on patients suffering from mild to moder- ate asthma. Desloratadin, as part of the treatment protocols, can obviously improve the patients＇ nasal symptoms and lung function.