布地奈德雾化佐治小儿气管插管拔管后的临床疗效观察

Clinical observation of the effect of budesonide atomization on tracheal extubation in children

目的观察布地奈德雾化吸入佐治小儿气管插管拔管后的临床疗效。方法收集2013年5月——2016年9月天津市儿童医院感染科收治的不同疾病导致气管插管患儿共85例,随机分为布地奈德组(44例)和地塞米松组(41例)。布地奈德组于拔管前30min予布地奈德混悬液1mg雾化吸入,拔管后立即予1mg雾化吸入,之后4d每8h予布地奈德混悬液0.5~1.0mg雾化吸入。地塞米松组于拔管前30min静脉应用地塞米松0.2~0.3mg/kg,拔管后立即予2.5~5.0mg雾化吸入,之后4d每8h予2.5~5.0mg雾化吸入。比较2组拔管成功率,喉水肿(拔管后喘鸣、声音嘶哑)发生率、消退时间,拔管后24h内出现缺氧表现、再次插管率以及继发感染率。结果 2组间拔管成功率、喉水肿发生率、消退时间,缺氧发生率以及再次插管率差异均无统计学意义(P>0.05);地塞米松组2例拔管后出现继发感染。结论布地奈德和地塞米松在防治拔管后喉水肿方面均有疗效,布地奈德雾化可以替代全身应用糖皮质激素,从而减少激素不良反应。推荐使用布地奈德防治气管插管拔管后不良反应。

Objective To investigate the effect of budesonide atomization on tracheal extubation in children.Methods A total of85patients with tracheal intubation in Tianjin Children’s Hospital from May2013to September2016were selected in this study.Patients were randomly divided into budesonide group(n=44)and dexamethasone group(n=41).The budesonide group was given1mg of budesonide for inhalation30min before extubation,and1mg of budesonide inhalation immediately after extubation.Then every8hours for0.5-1.0mg budesonide inhalation for4days.The dexamethasone group was given dexamethasone0.2-0.3mg/kg intravenously30min before extubation,and dexamethasone2.5-5.0mg inhalation immediately after extubation.Then dexamethasone2.5-5.0mg inhalation was given every8hours for4days.The incidence of laryngeal edema(stridor,hoarseness),the time of extinction,the expression of hypoxia,reintubation rate within24hours and secondary infection rate after extubation were compared between the two groups.Results There were no significant differences in the mission success rate,the incidence of laryngeal edema,the time of extinction,the incidence of hypoxia and re-intubation rate between the two groups(P>0.05).Two patients were found secondary infection after extubation in dexamethasone group.Conclusion Both budesonide and dexamethasone show curative effects on the prevention and treatment of laryngeal edema after extubation.Budesonide atomization can replace systemic corticosteroids,thus reducing the adverse reactions of glucocorticoids.We recommend the use of budesonide in treating adverse events after extubation.