3种布地奈德雾化方案对5岁以下儿童复发性喘息干预的研究

Efficacy Study of Three Different Schemes of Budesonide in Recurrent Wheezing Children under 5 Years Old

目的探讨每日及2种不同间歇雾化吸入布地奈德(budesonide,BUD)方案干预5岁以下儿童复发性喘息的疗效,为其早期选择恰当的干预方案提供依据。方法以年龄在12个月~59个月之间,有喘息反复发作,且m API阳性的160例患儿作为随访对象。按入院时间顺序随机分为3组:每日低剂量雾化吸入BUD组(每日组)54例、间歇高剂量早期雾化吸入BUD组(早期组)及间歇一般剂量抢先雾化吸入BUD组(抢先组)各53例。所有患儿治疗随访1年。比较各组糖皮质激素使用疗程数、喘息发作次数、因咳喘静脉治疗次数、急诊次数、有症状天数及呼吸道症状评分等指标;同时比较各组治疗前后全身用糖皮质激素疗程数、静脉治疗次数、喘息发作次数、急诊次数及住院率。结果 160例患儿中因退组等原因有10人未完成试验,实际收集病例150例,每组50例。3组治疗后均能减少全身用糖皮质激素疗程数、静脉治疗次数、喘息发作次数、急诊次数及住院率,差异有统计学意义(P<0.01);3组随访1年期间全身用糖皮质激素疗程数,喘息发作次数,静脉治疗次数,有症状天数,急诊次数比较差异无统计学意义(P>0.05)。呼吸道症状评分,因喘息住院病人数,治疗失败率,使用SABA天数,3组间比较亦未见显著差异(P>0.05)。两种间歇吸入方案使用BUD天数及BUD剂量较每日吸入方案少(P<0.01),其中抢先组使用BUD剂量最少(P<0.01)。结论早期及抢先间歇吸入BUD方案与每日吸入BUD方案临床疗效接近,使用BUD天数及剂量均较每日方案少;抢先组给药时间更早,使用BUD量最少,给药时间较早期组更灵活,可作为5岁以下m API阳性的复发性喘息儿童的防治方案之一。

OBJECTIVE To explore the curative effect of the daily and two different methods of intermittent atomization inhalation of budesonide（BUD） in the treatment of recurrrent wheezing children under 5 years old, providing the basis for early selection of ap- propriate intervention regimen for them. METHODS We studied 160 children between the aged 12 and 59 months who had positive values on the modified API （mAPI） , recurrent wheezing episodes. Children were randomly divided into three groups according to admis- sion time sequence：daily low dose atomization inhalation group （daily group） 54 cases, intermittent high dose early atomization inhala- tion group （early group） 53 cases and intermittent general dose preemptive atomization inhalation group （preemptive group） 53 cases. All children were observed for 1 year. Number of systemic cortieosteroids courses, wheezing episodes, intravenous, the emergency number, symptomatic days, respiratory symptom scores and other curative effect indicators were compared between the three groups; and compare the number of systemic corticosteroids courses, intravenous, wheezing episodes, the emergency number, and hospitalization rates before and after treatment in each group. RESULTS In this study, 10 children failed to complete the test because of various reasons, 150 cases were effective, each group 50 cases. All three groups can reduce the number of systemic corticosteroids courses,intravenous, wheezing episodes ,the emergency number and hospitalization rate ,the difference were statistically significant（ P 〈 0. 01 ）. There were no statistical significant difference between the three group in the number of systemic corticosteroids courses, wheezing episodes, intrave nous, the emergency number, symptomatic days （P 〉 0. 05 ） ;there was no significant difference between the respiratory symptom scores, the number of hospitalized patients, treatment failure rate, and use SABA days of the three group （ P 〉 0. 05 ）. The BUD use days and doses of intermittent inhalation regimens is less than daily inhalation regimen（ P 〈 0. 01 ） ; among the three groups, the preemptive group used the least dose（P 〈 0. 01 ）. CONCLUSION The efficacy of early and preemptive group is close to the daily group, and BUD days and doses of the early and preemptive group is less than that of daily group. The drug administration time of preemptive group was earlier and the overall drug delivery time is more flexible than early group, so the preemptive regimen can offer new options for 5-year-old children with recurrent wheezing and positive values on the mAPI.