气道湿化疗法治疗婴幼儿百日咳的临床研究

Airway humidification therapy for pertussis in infants

目的观察气道湿化疗法用于婴幼儿百日咳痉咳期的临床效果。方法选择2020年5月至2021年9月在温州市中西医结合医院就诊的百日咳患儿60例为研究对象,按照随机数字表法分为研究组(30例)和对照组(30例)。对照组患儿予以常规药物治疗,研究组患在常规药物治疗基础上增加气道湿化治疗。评价患儿百日咳临床疗效水平,记录患儿临床症状改善周期及住院时间,分别于治疗前后检测患儿肺功能指标及血清炎性因子水平,观察百日咳相关并发症。结果研究组总体治疗有效率(100.0%)显著高于对照组水平(76.7%)(χ^(2)=5.82,P=0.016);研究组患儿痉挛性咳嗽消失时间、发绀消退时间、肺部啰音消失时间和住院时间[(3.10±0.67)d、(1.53±0.68)d、(4.27±0.58)d和(11.57±0.73)d]均显著短于对照组[(4.23±1.99)d、(2.67±1.77)d、(5.63±2.38)d和(13.33±2.40)d](t=2.93、3.27、3.04、3.86,P=0.005、0.002、0.003、P < 0.001)。研究组患儿治疗后呼吸频率(RR)(21.83±1.15)次/min,显著低于对照组(24.23±3.12)次/min,而每千克体质量潮气量(VT/kg)、达峰时间比(TPEF/TE)和达峰容积比(VPEF/VE)[(10.70±0.81)mL/kg、(41.60±1.57)%和(42.89±1.44)%]均显著高于对照组[(9.78±1.34)mL/kg、(39.18±3.37)%和(40.20±3.05)%](t=3.94、3.21、3.56、4.36,P=0.002、P < 0.001、P=0.001、P < 0.001)。研究组患儿血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和白细胞介素8(IL-8)含量[(62.44±2.96)ng/L、(46.59±1.96)ng/L和(54.63±3.27)ng/L]均显著低于对照组水平[(79.86±3.30)ng/L、(58.20±2.10)ng/L和(63.31±3.86)ng/L](t=21.53、22.13、9.38,均P < 0.001)。研究组患儿百日咳并发症总体发生率(3.3%)显著低于对照组水平(26.7%)(χ^(2)=4.71,P=0.030)。结论气道湿化治疗可缩短百日咳患儿痉咳期症状改善周期,提高临床疗效,增强肺通气功能,减轻呼吸道炎性反应,降低百日咳相关并发症风险。

Objective To investigate the effects of airway humidification therapy on pertussis in infants.Methods Sixty children with pertussis who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2020 to September 2021 were included in this study.They were randomly divided into study and control groups,with 30 infants per group.The control group was treated with conventional drugs.The study group was subjected to airway humidification therapy based on conventional drug treatment.Clinical efficacy was evaluated in each group.Time to an improvement in clinical symptoms and length of hospital stay were recorded.Lung function indicators and serum inflammatory factor levels were determined before and after treatment.Pertussis-related complications were recorded.Results The overall response rate in the study group was significantly higher than that in the control group(100.00%vs.76.7%,χ^(2)=5.82,P=0.016).Time to disappearance of spastic cough,time to resolution of cyanosis,time to disappearance of pulmonary rales,and length of hospital stay in the study group were(3.10±0.67)days,(1.53±0.68)days,(4.27±0.58)days,and(11.57±0.73)days,respectively,which were significantly shorter than(4.23±1.99)days,(2.67±1.77)days,(5.63±2.38)days,(13.33±2.40)days(t=2.93,3.27,3.04,3.86;P=0.005,0.002,0.003,P<0.001).Respiratory rate in the study group was significantly lower than that in the control group[(21.83±1.15)breaths/minute vs.(24.23±3.12)breaths/minute,t=3.94,P=0.002].Tidal volume/kg body weight,the ratio of time to peak expiratory flow to total expiratory time and the ratio of volume to peak expiratory flow to total expiratory volume in the study group were(10.70±0.81)mL/kg,(41.60±1.57)%,(42.89±1.44)%,respectively,which were significantly higher than(9.78±1.34)mL/kg,(39.18±3.37)%,(40.20±3.05)%in the control group(t=3.21,3.56,4.36;P<0.001,P=0.001,P<0.001).Serum tumor necrosis alpha(TNF-α),interleukin-6 and interleukin-8 levels in the study group were(62.44±2.96)ng/L,(46.59±1.96)ng/L,(54.63±3.27)ng/L,respectively,which were significantly lower than(79.86±3.30)ng/L,(58.20±2.10)ng/L,(63.31±3.86)ng/L in the control group(t=21.53,22.13,9.38,all P<0.001).The overall incidence of pertussis in the study group was significantly lower than that in the control group(3.3%vs.26.7%,χ^(2)=4.71,P=0.030).Conclusion Airway humidification therapy can shorten the time to reduction of symptoms of spasmodic pertussis,improve clinical efficacy,strengthen pulmonary ventilation function,lower respiratory tract inflammatory responses and reduce the risk of pertussis-related complications.