三种雾化吸入方案治疗婴幼儿急性喘息疗效比较

Comparison of the Efficacy of Different Inhalation Therapies for Infant Acute Wheezing

目的：比较三种雾化吸入方案治疗婴幼儿急性喘息的临床疗效,探究更快缓解喘息症状的治疗方案。方法：将179例急性喘息婴幼儿随机分A、B、C 3组,A组每8 h 1次雾化吸入硫酸特布他林溶液2.5 mg和异丙托溴铵溶液0.25 mg;B组在A组基础上加用布地奈德混悬液0.5 mg,2次/天雾化吸入;C组在A组基础上加用布地奈德混悬液1 mg,每8 h 1次雾化吸入。治疗3-5 d后比较各组治疗前后临床症状、体征变化及速效β2受体激动剂（SABA）和全身型激素使用情况。结果：治疗30 min后,C组喘息急性发作评分改善较A、B两组更加显著（Z=-4.26及Z=-3.45,P〈0.01）,A、B两组比较差异无统计学意义（Z=1.17,P〉0.05）。治疗3 d及5 d后三组间评分比较差异无统计学意义（H=2.86及H=0.60,P〉0.05）。三组速效β2受体激动剂和全身激素使用情况比较差异无统计学意义（χ^2=1.74及χ^2=0.95,P〉0.05）。结论：对于轻中度喘息急性发作婴幼儿,小剂量吸入型糖皮质激素（ICS）雾化吸入治疗不能明显提高疗效,早期大剂量使用ICS能够更快地缓解症状,但对后续疗效的提高没有明显促进作用。

Objective： To compare the efficacy of three different inhalation therapies for infant acute wheezing and explore the treatment which can provide more rapid symptoms relieve. Methods： Totally 179 infants of acute wheezing were randomly divided into three groups. All of the infants were treated with inhaled terbutaline sulfate and ipratropium bromide. Group B,plus budesonide suspension0. 5 mg bid. Group C,plus budesonide suspension 1 mg q 8 h. The improvement of clinical symptoms and signs of the infants in three groups were recorded and compared respectively,3 - 5 days after treatment. Results： Compared with group A and group B,the scores of acute episode of wheezing improved more significantly in group C at the time of 30 minutes after treatments（ Z =-4. 26 and Z =-3. 45,P〉0. 01）. There was no statistical difference between the improvements of group A and B（ Z = 1. 17,P〉0. 05）. The clinical symptoms and signs of the three groups improved significantly after 3 - 5 days after treatments,but there was no statistical difference（ H = 2. 86 and H = 0. 60,P 〉0. 05）. Meanwhile,there was no significant difference in the use of SABA and systemic corticosteroids in three groups（ χ^2= 1. 74 and χ^2= 0. 95,P〉0. 05）. Conclusion： For infants with mild-to-moderate acute wheezing episodes,treatment with inhaled corticosteroid in low dosage can not significantly improve the efficacy. However,early and high-dose of inhaled corticosteroid using can improve the symptoms more quickly. But no effect on the improvement of the follow-up efficacy was observed.