不同浓度盐水雾化吸入治疗毛细支气管炎临床观察

Clinical observation of nebulized different concentration saline in treatment of bronchiolitis

目的：比较不同浓度盐水雾化吸入治疗毛细支气管炎住院患儿的临床疗效、安全性及其经济性。方法：纳入2012年1月至12月本院儿童呼吸科的毛细支气管炎住院患儿共66例,用随机数字表将患者分成3组,分别为0.9%Na Cl组、3%Na Cl组、5%Na Cl组,分别给予0.9%Na Cl液3 m L、3%Na Cl液3 m L、5%Na Cl液3 m L雾化吸入。采用空气压缩雾化器与面罩吸入,入院12 h内接受治疗每天3次（早上、中午、晚上,间隔4 h以上）直至出院。主要观察指标包括临床严重度评分（CBSS）、住院时间、不良事件发生率及住院费用。结果：各组毛细支气管炎患儿入院第1-第3天的临床严重度评分（CBSS1、CBSS2、CBSS3）、住院时间、临床症状缓解时间等比较,差异无统计学意义（P〉0.05）。5%Na Cl组不良事件发生率为12.2%,显著高于0.9%Na Cl组（为2.3%）和3%Na Cl组（为4.6%）,差异有统计学意义（x^2=34.199,P〈0.01）。不良事件主要包括雾化过程中出现普通咳嗽、剧烈咳嗽和呕吐。结论：毛细支气管炎住院患儿治疗中应用高渗盐水（3%Na Cl液、5%Na Cl液）与0.9%Na Cl液雾化吸入的疗效相当且未增加医疗费用;3%Na Cl液雾化吸入的安全性较5%Na Cl液好,但两者均未出现明显严重不良事件。

Objective： To compare the efficacy, safety and expenses of nebulized different concentration saline in treatment of hospitalized bronchiolitis. Methods： There were 66 patients enrolled in the clinical trial from January to December 2012 in the ward of Respiratory Department of the Yuying Children＇s Hospital Affiliated to Wen Zhou Medical University. They were randomised to three groups, including 0.9% saline（NS） group, 3% hypertonic saline（3% HS） group and 5% hypertonic saline（5% HS） group. 0.9% normal saline solution 3 m L, 3% hypertonic saline solution 3 m L and 5% hypertonic saline solution 3 m L were given to patients in the three groups respectively, patients received nebulizations three times everyday, delivered at intervals of more than 4 h by air-compressed nebulizers and face masks until discharge. The primary efficacy outcome of the study was Clinical Bronchiolitis Severity Score, length of stay, the rate of adverse events and hospital expenses. Results： There was no significance difference in the Clinical Bronchiolitis Severity Score from the first day to the third day, neither in length of stay nor in symptom relieved time among the three groups（P〉0.05）. The rate of adverse events was 12.2% in 5% HS group, which was significantly higher than other two groups（2.3% in NS group, 4.6% in 3% HS group）（x^2=34.199, P〈0.01）. The adverse events included common cough, severe cough and vomit. Conclusion： The effectiveness of nebulized hypertonic saline may not be superior to inhalation of normal saline in treatment of patients hospitalized with bronchiolitis. Nebulized hypertonic saline will not increase the medical expenses. In contrast with 5% hypertonic saline, inhalation of 3% hypertonic saline is a relative safe therapy for patients with bronchiolitiss, yet no severe adverse events have happened.