异丙托溴铵与β2受体激动剂治疗哮喘患儿的最佳协同剂量及对心率变异性的影响

Optimal synergistic dose of ipratropium bromide and β2 agonist in asthmatic children and its effect on heart rate variability

目的 探讨异丙托溴铵与β受体激动剂治疗哮喘患儿的最佳协同剂量及对心率的影响。方法 选取2019年6月至2021年6月本院收治的60例哮喘急性发作患儿作为研究对象,根据治疗方法不同分为两组,每组30例。A组给予大剂量雾化吸入1次沙丁胺醇(0.15 mg/kg)和异丙托溴胺(10 mg/kg),B组每20分钟雾化吸入1次小剂量沙丁胺醇(0.1 mg/kg)和异丙托溴胺(5 mg/kg)。比较两组肺功能指标、哮喘症状控制测试(ACT)、心率变化指标。结果 治疗前,两组肺功能指标比较差异无统计学意义,治疗结束时,B组FEV_(1)和FVC水平均明显高于A组(P<0.05);随着治疗时间的延长,患儿ACT评分均明显升高,且B组变化更为明显,治疗40、60 min时,B组ACT评分均高于A组,差异有统计学意义(P<0.05);两组心率、心率变异系数和心电图异常率比较差异无统计学意义。结论 异丙托溴铵与β受体激动剂联合治疗急性哮喘患儿可协同增强疗效,具有相辅相成的互补作用,小剂量多次给药是较安全且有效的方法。

Objective To investigate the optimal synergistic dose of ipratropium bromide and βagonist in the treatment of children with asthma and the effect on heart rate. Methods 60 cases of children with acute attack of asthma from June 2019 to June 2021 in our hospital were selected as the research subjects, and they were divided into two groups according to different treatment methods, with 30 cases in each group. Group A received one dose of high-dose aerosol inhalation of salbutamol(0.15 mg/kg) and ipratropium bromide(10 mg/kg), while group B received one dose of lowdose salbutamol(0.1 mg/kg) and ipratropium bromide(5 mg/kg) every 20 min. Pulmonary function indexes, asthma control test(ACT) and heart rate change indexes were compared between the two groups. Results Before treatment, there was no significant difference in the lung function indexes between the two groups;at the end of treatment, the levels of FEV_(1)and FVC in group B were significantly higher than those in group A(P<0.05);with the extension of treatment time, the ACT score of the children increased significantly, and the change was more obvious in group B. After 40and 60 minutes of treatment, the ACT score of group B was higher than that of group A, the difference was statistically significant(P<0.05);there were no significant differences in heart rate, heart rate variation coefficient and ecg abnormality rate between the two groups. Conclusion The combination of ipratropium bromide and βagonist in the treatment of children with acute asthma can synergically enhance the efficacy and complement each other, and multiple administration of small dose is a safe and effective method.