影响3%高渗盐水雾化吸入治疗毛细支气管炎患儿疗效的多因素分析

Multivariate analysis of efficacy of nebulized inhalation of 3% hypertonic saline in pediatric inpatient with bronchiolitis

目的探讨3%高渗盐水雾化吸入治疗毛细支气管炎的有效性及影响其疗效的因素。方法回顾性分析2009年6月至2012年12月住院患儿中首要诊断为毛细支气管炎且已完善鼻咽抽吸物16种常见呼吸道病毒检测的病例资料。以治疗2天后临床严重程度评分下降百分比和住院时间作为终点指标评价3%高渗盐水雾化吸入治疗的有效性,并进一步寻找影响其疗效的因素。结果 3%高渗盐水雾化吸入治疗组患儿2天后严重程度评分平均下降42.86%（11.11%-66.67%）,显著高于未使用高渗盐水治疗组的平均下降率26.79%（0%-50.00%）,差异有统计学意义（P=0.006）;两组患儿住院时间差异无统计学意义（P=0.26）。多重线性回归分析显示,年龄〉3个月、母乳喂养、呼吸道合胞病毒（RSV）感染及肺部听诊可闻及广泛哮鸣音的患儿疗效更好,该多重线性回归分析模型具有统计学意义（R2=0.58,P3个月、母乳喂养、RSV感染、肺部闻及广泛哮鸣音的毛细支气管炎住院患儿,疗程为2-3天。

Objective To evaluate the efficacy and influencing factors of 3% hypertonic saline（HS） inhalation in treatment of bronchiolitis.Methods Clinical data together with the detection of 16 types of respiratory tract virus from hospitalized pediatric patients with primary diagnosis of bronchiolitis from June 2009 to December 2012 were retrospectively analyzed.The endpoint indicators for evaluation on the efficacy of nebulized 3% HS inhalation were the percent decrease of clinical severity（CS） score after 2 days＇ treatment and the hospitalization time.Factors affecting efficacy were further explored.Results The CS score in nebulized 3% HS treated group decreased in average of 42.86%（11.11%-66.67%）,significantly higher than that（26.79%,0.00%-50.00%） in the untreated group（P=0.006）.No difference of between the two groups（P=0.26）.Multiple linear regression analysis showed that nebulized 3% HS inhalation has better efficacy on the patients older than 3 months having breastfeeding,respiratory synthetic syncytial virus（RSV） infection and extensive wheezing sound auscultation of the lungs.The multiple linear regression analysis model was statistically significant（R2=0.58,P〈0.001）.Conclusions After 2 days＇ treatment with 3% hypertonic saline inhalation,the CS score of bronchiolitis patients was decreased.The treatment can be recommended in hospitalized patient older than 3 months with breastfeeding,RSV infection,and extensive wheezing sound auscultation of the lungs.