异丙托溴铵联合布地奈德、特布他林雾化吸入对支气管肺炎患儿细胞因子的影响

Effect of aerosol inhalation of ipratropium bromide in combined with budesonide and terbutaline on the cytokines in children with bronchopneumonia

目的：探讨异丙托溴铵联合布地奈德、特布他林雾化吸入治疗小儿支气管肺炎临床疗效及对细胞因子的影响。方法：选取70例小儿支气管肺炎患儿为研究对象,随机分为研究组与对照组,对照组给予抗感染、吸氧、止咳平喘及纠正酸中毒等基础治疗,并采用布地奈德0.5mg/次、特布他林1.0mg/次联合面罩＋氧气驱动雾化吸入,氧流量为5~7L/min,每次5~10min,2次/d,研究组在上述基础上联合异丙托溴铵1.0mg/次吸入,两组均治疗7d进行疗效评价;检测治疗前后白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C-反应蛋白（CRP）、白细胞计数（WBC）水平;测定治疗前后肺功能,包括最高呼气流速（PEF）、用力肺活量（FVC）及第1秒最大呼气量（FEV1）;观察临床症状和体征改善情况及不良反应发生情况。结果：治疗后两组IL-6、TNF-α、CRP水平及WBC计数均降低,与治疗前比较,差异具有统计学意义（P〈0.05）,研究组优于对照组,差异有统计学意义（P〈0.05）;治疗后两组PEF、FVC、FEV1较治疗前改善,与治疗前比较差异显著（P〈0.05）,研究组优于对照组,差异有统计学意义（P〈0.05）;治疗后研究组气喘缓解、止咳、啰音消失、胸片阴影消失等时间上均短于对照组,差异有统计学意义（P〈0.05）;两组均未出现严重不良反应,两组比较,差异无统计学意义（P〉0.05）。结论：异丙托溴铵联合布地奈德、特布他林雾化吸入可快速缓解小儿支气管肺炎患儿症状,改善炎性因子水平,且无明显不良反应,值得临床推广。

Objective： To explore the clinical efficacy of aerosol inhalation of ipratropium bromide in combined with budesonide and terbutaline on bronehopneumonia in children and the effect on cytokines. Methods： A total of 70 children with bronehopneumonia who were admitted in our hospital were included in the study and randomized into the study group and the control group. The patients in the control group were given anti-infection, oxygen inhalation, cough and asthma relieving, acidosis correcting, mask＋oxygen driven aerosol inhalation of budesonide （0.5 rag/time） and terbutaline （1.0 rag/time）, with an oxygen flow rate of （5-7） L/min, （5-10） rain every time, twice a day. On the above basis, the patients in the study group were given additional ipratropium bromide （1.0 mg/time）. After 7 day treatment, the efficacy was evaluated. The levels of IL-6, TNF-α, CRP, and WBC before and after treatment were detected. PEF, FVC, and FEV1 before and after treatment were detected. The improvement of clinical symptoms and signs, and the occurrence of adverse reactions were observed. Results： The levels of IL-6, TNF-a, CRP, and WBC counting after treatment in the two groups were significantly reduced when compared with that before treatment （P〈0.05）, and the reduced degree in the study group was significantly superior to that in the control group （P〈0.05）. PEF, FVC, and FEV1 after treatment in the two groups were significantly improved when compared with before treatment （P〈0.05）, and the improved degree in the study group was significantly superior to that in the control group （P〈0.05）. After treatment, the cough and asthma relieving, and rale and DR shadow disappearing time in the study was significantly shorter than that in the control group （P〈0.05）. No severe adverse reactions occurred in the two groups, and the comparison between the two groups was not statistically significant （P〉0.05）. Conclusions; Ipratropium bromide in combination with budesonide and terbutaline in the treatment of bronchopneumonia in children can rapidly relieve the symptoms, and improve the cytokine level, with no obvious adverse reactions; therefore, it deserves to be widely recommended in the clinic.