婴幼儿喘息患者的肺功能评估及相关药物干预有效性研究

Evaluation of pulmonary function in infants with wheezing and the effectiveness of drug intervention

目的探讨婴幼儿喘息患者的肺功能评估对药物干预方案的指导作用。方法选择2016年4月至2019年3月在本院治疗的≤5岁喘息患儿312例,随机分为观察组和对照组各156例。第1~4周,观察组所有患儿给予糖皮质激素+β2受体激动剂吸入+口服孟鲁司特钠治疗,对照组仅给予孟鲁司特钠;第5~8周,观察组患儿给予糖皮质激素雾化吸入+孟鲁司特钠,对照组仅给予孟鲁司特钠;第9~12周,观察组患儿仅给予孟鲁司特钠,而对照组不给予任何药物干预。比较采用不同治疗方案者哮喘症状评分和喘息复发次数的差异。结果哮喘预测指数(API)阳性者、中度阻塞者和舒张试验阳性者中,观察组在治疗8周、12周后的哮喘症状更轻,而重度阻塞者中,观察组在治疗4周、8周和12周后的哮喘症状更轻,差异有统计学意义(P<0.05);但API阴性者、轻度阻塞者和舒张试验阴性者,两种干预方案对哮喘症状的改善情况比较差异无统计学意义(P>0.05)。API阳性者、中度和重度阻塞者和舒张试验阳性者中,观察组12周内喘息复发率显著低于对照组,差异有统计学意义(P<0.05);对于API阴性者、轻度阻塞者和舒张试验阴性者,两种干预方案的复发率比较差异无统计学意义(P>0.05)。结论对于婴幼儿喘息患者,在疾病早期通过API预测、潮气分析和支气管舒张试验来评估肺功能状况,有利于药物干预方案的科学制定。对于肺功能评估可能进展为哮喘的患儿,应当尽早给予糖皮质激素、β2受体激动剂和白三烯受体拮抗剂的联合用药方案,并依据病程和病情变化以及家庭状况进行用药方案的调整。

Objective To explore the guiding role of pulmonary function assessment for drug intervention program in infants with wheezing.Methods A total of 312 children with asthma less than or equal to 5 years old admitted to our hospital from April 2016 to March 2019 were enrolled. The children were randomly divided into observation group and control group, 156 cases in each group. During week 1-4, the children in observation group were given inhalation of glucocorticoid+beta 2 receptor agonist + oral montelukast sodium, while the children in control group were given montelukast sodium only. During week 5-8, the children in observation group were given inhalation of glucocorticoid + oral montelukast sodium, while the children in control group were given montelukast sodium only. During week 9-12, the children in observation group were given montelukast sodium only, while the control group was not given any drug intervention. The difference in asthma symptom score and the number of wheezing relapses among different groups were compared.Results In the infants with positive asthma prediction index(API), moderate obstruction and positive diastolic test, the asthmatic symptoms were milder in the observation group after 8 and 12 weeks of treatment, while the asthmatic symptoms were milder in the severe obstructive patients after 4, 8 and 12 weeks of treatment(P<0.05), but there was no significant difference in the improvement of asthmatic symptoms of patients with negative API, mild obstruction and negative diastolic test between the two intervention schemes(P>0.05). The recurrence rate of wheezing within 12 weeks in positive API, moderate and severe obstruction and positive diastolic test patients was significantly lower in the observation group than in the control group(P<0.05), but there was no significant difference in the recurrence rate of negative API, mild obstruction and negative diastolic test patients between the two intervention programs(P>0.05).Conclusion For infants with wheezing, API prediction, tidal analysis and bronchodilation test can be used to evaluate pulmonary function in the early stage of the disease, which is helpful for the scientific formulation of drug intervention programs. For children whose pulmonary function assessment suggests progress to asthma, the combination regimen of glucocorticoid, beta-2 receptor agonist and leukotriene receptor antagonist should be given as soon as possible, and the medication regimen should be adjusted according to the course and condition of the disease and family condition.