阿奇霉素在婴幼儿喘息联合降阶梯疗法中的疗效

Therapeutic effect of Azithromycin in the combine-sequential therapy for infants with wheezing

目的 前期的研究已经证明联合降阶梯治疗方案治疗婴幼儿喘息急性期是安全有效的.本研究在此基础上探讨联合降阶梯治疗方案组分之一阿奇霉素在其中的作用.方法 将2012年8月至2013年4月在上海新华医院儿童呼吸科门诊就诊的56例婴幼儿喘息患儿按Excel表格随机分为阿奇霉素组29例,对照组27例.阿奇霉素组：口服阿奇霉素10 mg/（kg·d）×3d,口服泼尼松5 mg/d×3 d,每晚贴用妥洛特罗贴剂1贴（0.5 mg/d） ×7 d,口服氯雷他定3 mL/d×7 d,口服孟鲁司特纳4 mg/d ×7 d;对照组除无阿奇霉素外,其他药物用法与阿奇霉素组相同.在治疗第1、3、7天对患儿咳嗽、喘息、哮鸣音、排痰难易的症状进行评分.结果 1.阿奇霉素组和对照组均能改善喘息患儿的咳嗽、喘息、哮鸣音、排痰难易的症状,2组患儿治疗前后症状评分（5.41 ±1.40、4.85±1.31比1.14 ±0.78、2.93 ± 1.00）比较差异均有统计学意义（S=217.5、147.0,P均＜0.05）.2.阿奇霉素组喘息患儿咳嗽、喘息、哮鸣音、排痰难易症状的改善在治疗第3天（0.52±0.51、0.28±0.45、0.24±0.44、0.38 ±0.49比0.89 ±0.42、0.74±0.45、0.62±0.69、0.67 ±0.48）和第7天（0.24 ±0.44、0.21 ±0.41、0.07 ±0.26、0.21 ±0.41比0.52±0.51、0.48 ±0.51、0.37±0.49、0.48 ±0.51）均优于对照组,各项症状评分比较差异均有统计学意义（Z=2.75、3.44、2.90、2.12、2.11、2.13、2.71、2.13,P均＜0.05）.结论 阿奇霉素＋泼尼松＋妥洛特罗贴剂＋氯雷他定＋孟鲁司特组成的联合降阶梯疗法能改善喘息患儿急性期咳嗽、喘息、哮鸣音、排痰难易各项症状,阿奇霉素是婴幼儿喘息联合降阶梯治疗方案的有效组分之一.

Objective Early studies had confirmed that the combine-sequential therapy in the treatment of acute attacks of wheezing infants was safe and effective,this study aims to further explore the role of oral azithromycin in the combine-sequential therapy.Methods According to the principles of randomized,56 wheezing infants were divided into Azithromycin group and control group from Aug.2012 to Apr.2013,and there were 29 children in the Azithromycin group and 27 children in the control group.The treatment protocol of Azithromycin group were oral Azithromycin 10 mg/（kg · d）,3 days; oral prednisone 5 mg/d,3 days; Tulobuterol Patch 0.5 mg/d,7 days;oral Ioratadine 3 mL/d,7 days; oral Montelukast 4 mg/d,7 days.Control group was without Azithromycin,and the rest of drugs were the same as Azithromycin group.The symptom scores of coughing,wheezing,wheezing sound and the difficulty of expectoration in the 1 st day,the 3rd day,and the 7th day were recorded.Results 1.The Azithromycin group and the control group could both improve the children＇s symptom scores of coughing,wheezing,wheezing sound and the difficulty of expectoration,the 2 groups of children before and after treatment of the symptom scores differences were statistically significant （5.41 ± 1.40,4.85 ± 1.13 vs 1.14 ± 0.78,2.93 ± 1.00） （S =217.5,147.0,all P ＜ 0.05）.2.The Azithromycin group had more improvement at the symptom scores of coughing,wheezing,wheezing sound and the difficulty of expectoration than those of the control group in the third day （0.52 ±0.51,0.28 ±0.45,0.24 ±0.44,0.38 ±0.49 vs 0.89 ± 0.42,0.74 ±0.45,0.62 ±0.69,0.67 ±0.48）and the 7th day （0.24 ±0.44,0.21 ±0.41,0.07 ±0.26,0.21 ±0.41 vs 0.52 ±0.51,0.48 ±0.51,0.37 ±0.49,0.48 ±0.51）,and the symptom score differences were statistically significant（Z =2.75,3.44,2.90,2.12,2.11,2.13,2.71,2.13,all P ＜ 0.05）.Conclusions Azithromycin ＋ Tulobuterol patch ＋ Prednisone ＋ Loratadine ＋ Montelukast combination consisting of sequential therapy can improve children with acute wheezing cough,wheezing,wheezing,difficulty of the expectoration symptoms,azithromycin is an effective component of infants wheezing combined sequential treatment regimen.