辅舒良与孟鲁司特联合吸入治疗儿童哮喘合并过敏性鼻炎的临床体会

Study on the Effect of Combined Inhalation Therapy of Flixonase,Montelukastand Flixotide for Children with Bronchial Asthma and Allergic Rhinitis

目的 观察辅舒良、孟鲁司特联合辅舒酮治疗儿童哮喘合并过敏性鼻炎的临床效果.方法 选取2010年10月至2013年2月河北省阜城县人民医院收治的哮喘合并过敏性鼻炎患儿100例,采用辅舒良（丙酸氟替卡松水溶性鼻喷雾剂）喷两侧鼻孔各1次,孟鲁司特4 mg（＜6岁）或5 mg（6～ 14岁）,每日1次夜服,治疗4周后过敏性鼻炎症状若得到有效控制,改每日晨轮换鼻孔喷1次,联合口服孟鲁司特连续治疗3个月.同时储雾器吸入辅舒酮（丙酸氟替卡松）,每次125 μg（年龄＜5岁或轻度哮喘）或每次250μg（年龄＞5岁或中度、重度哮喘）治疗,每日2次,均连续治疗3个月.采用哮喘控制测试量表及过敏性鼻炎症状分级评分标准对患儿治疗前后哮喘控制情况和过敏性鼻炎症状进行评分,并进行疗效评定.结果 本组患儿治疗前支气管哮喘症状评分为（18.9±3.1）分,过敏性鼻炎症状评分为（2.5±0.4）分,治疗后分别为（24.5±2.1）分和（1.0±0.3）分,治疗前后比较差异有统计学意义（P＜0.05）.在治疗后3个月,2例（2％）无明显效果,78例（78％）治愈,20例（20％）好转,总有效率为98％.结论 辅舒良、孟鲁司特联合吸入型激素辅舒酮治疗儿童支气管哮喘及过敏性鼻炎,可有效控制患者哮喘及过敏性鼻炎症状,降低复发率.

Objective To observe the clinical effect of the combined inhalation therapy of flixonase,montelukast and flixotide for children with bronchial asthma and allergic rhinitis.Methods A total of 100 cases of children with bronchial asthma and allergic rhinitis admitted in People＇s Hospital of Fucheng County from Oct.2010 to Feb.2013 were treated with flixonase（fluticasone propionate water-soluble nasal spray）to spray both sides of the nose once per day,4 mg montelukast for children under 6 years or 5 mg for children between 6 and 14 years old,daily taken once at night.After 4 weeks of treatment,if the symptoms of allergic rhinitis had been effectively controlled,the daily therapy of montelukast was changed to alternate nostril spray once every morning,for 3 consecutive months.At the same time,flixotide（fluticasone propionate） was given by mist reservoir,125 μg/time （for children under 5 years or with mild asthma）or 250 μg/time （for children above 5 years or with moderate and severe asthma）,twice per day,for 3 consecutive months.The status of the asthma control before and after treatment was scaled using asthma control test scale by 2005 Thoracic Society Development,and the symtoms of allergic rhinitis before and after treatment was scaled using the allergic rhinitis symptom score standard.Moreover,the therapeutic effect was evaluated.Results The bronchial asthma symptom score of this group of children was （18.9 ± 3.1） points before treatment,and allergic rhinitis symptom score was （2.5 ±0.4） points before treatment,and respectively （24.5 ±2.1）points,（1.0 ± 0.3） points after treatment,there were statistically significant differences before and after treatment（P ＜ 0.05）.After 3 months of treatment,there was no significant effect on 2 cases（2％）,and 78 cases（78％） were cured,another 20 cases（20％） got improved,the total effective rate was 98％.Conclusion The combined inhalation therapy of flixonase,montelukast and flixotide for children with bronchial asthma and allergic rhinitis can effectively control the symptoms for the patients and reduce the recurrence rate.