难治性哮喘患儿个体化治疗的临床研究

Clinical study on individualized treatment of children with refractory asthma

目的 观察儿童难治性哮喘的个体化治疗与转归,以提高临床医生对该病的诊治水平。方法 对2016年1月-2022年12月于北京清华长庚医院就诊的26例难治性哮喘患儿的临床资料进行回顾性分析。患儿入组前均接受常规哮喘控制药物治疗,吸入布地奈德福莫特罗粉吸入剂,每次1吸,bid,疗程3个月。入组后均给予联合口服孟鲁司特钠咀嚼片(<15岁用5 mg,≥15岁用10 mg),每晚1片,疗程3个月。同时,针对患儿的不同共患病(过敏性鼻炎、慢性鼻窦炎、反复呼吸道感染、肺炎支原体感染、胃食管反流),采取不同的个体化治疗方案(氯雷他定片、糠酸莫米松鼻喷剂、头孢克洛干混悬剂、槐杞黄颗粒、阿奇霉素片、奥美拉唑肠溶胶囊)。比较个体化治疗前后患儿肺功能检测指标,包括用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、1秒率(FEV_(1)/FVC)、呼气流量峰值(PEF)、呼出气一氧化氮数值(FeNO)、哮喘发作次数,监测药物不良反应发生情况。结果 治疗前与治疗后,患儿的FVC分别为(1.92±0.23)和(3.23±0.52)L,FEV_(1)分别为(1.86±0.35)和(3.06±0.31)L,FEV_(1)/FVC分别为(66.58±2.63)%和(85.26±3.02)%,PEF分别为(3.45±0.58)和(6.08±0.63)L·s^(-1),FeNO分别为(39.86±6.84)和(20.32±3.36)ppb,哮喘发作次数分别为(3.24+0.35)和(1.19±0.13)次,差异均有统计学意义(均P<0.05)。患儿的药物不良反应发生率为11.54%。结论 明确儿童难治性哮喘的病因,针对哮喘共患病进行规范合理、个体化的联合治疗,可提高儿童难治性哮喘的控制水平。

Objective To observe the individualized treatment and prognosis of refractory asthma in children to improve the diagnosis and treatment level of clinical doctors.Method A retrospective analysis was conducted on the clinical data of 26 children with refractory asthma who were treated at Tsinghua Changgung hospital in Beijing from January 2016 to December 2022.The enrolled children were treated with conventional asthma control drugs before treatment,and budesonide and formoterol fumarate powder for inhalation,once a time,bid,and the course of treatment was 3 months.After enrollment,all patients were given montelukast sodium chewable tablets(5 mg for<15 years old,10 mg for≥15 years old),oral,1 tablet per night,with a course of 3 months.At the same time,different individualized treatment schemes(loratadine tablets,mometasone furoate aqueous nasal spray,cefaclor for suspension,Huaiqihuang granules,azithromycin dispersible tablets,omeprazole enteric-coated capsules)were adopted for different comorbidity of children(allergic rhinitis,chronic Sinusitis,recurrent respiratory infections,mycoplasma pneumonia infection,gastroesophageal reflux disease).The pulmonary function indexes of children before and after individualized treatment were compared,including forced forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),FEV_(1)/FVC,peak expiratory flow(PEF),fractional exhaled nitric oxide(FeNO)and the number of asthma attacks.The incidence of adverse drug reaction was monitored.Results Before and after treatment,the FVC of the patient were(1.92±0.23)and(3.23±0.52)L,FEV_(1) were(1.86±0.35)and(3.06±0.31)L,FEV_(1)/FVC were(66.58±2.63)%and(85.26±3.02)%,PEF were(3.45±0.58)and(6.08±0.63)L·s^(-1),FeNO were(39.86±6.84)and(20.32±3.36)ppb,the number of asthma attacks were(3.24+0.35)and(1.19±0.13),respectively.The differences were statistically significant(all P<0.05).The incidence of adverse drug reaction was 11.54%.Conclusion Identifying the etiology of refractory asthma in children and standardized,reasonable,and individualized combination therapy for comorbidities of asthma can improve the control level of refractory asthma in children.