肺部康复训练在沙丁胺醇治疗重度支气管哮喘急性期患儿中的效果

Clinical effect of lung rehabilitation training in children with severe bronchial asthma treated with salbutamol in acute stage

目的分析肺部康复训练在沙丁胺醇治疗重度支气管哮喘急性发作患儿中对气道炎症因子和肺功能的影响,为临床治疗重度支气管哮喘急性发作提供治疗依据。方法选取郑州大学第三附属医院2021年9月至2023年2月收治的102例重度支气管哮喘急性发作患儿进行前瞻性研究,采用随机数字表法将其分为两组(参照组、治疗组),每组51例。参照组男32例、女19例;年龄5~12(7.32±1.85)岁;病程2~18(12.30±1.28)个月;体质量12~27(21.65±2.08)kg。治疗组男28例、女23例;年龄6~13(7.94±1.16)岁;病程2~17(11.89±2.31)个月;体质量11~28(22.32±2.17)kg。入院后两组患儿均予以布地奈德抗感染治疗,参照组采用沙丁胺醇治疗,治疗组采用沙丁胺醇联合肺部康复训练,两组患儿治疗周期均为1个月。比较两组患儿临床效果,临床症状(呼吸困难、咳嗽、喘息、哮鸣音、湿啰音)消失时间,治疗前及治疗后1个月炎症因子水平[白细胞介素-4(interleukin-4,IL-4)、IL-18、IL-1β、嗜酸性粒细胞(eosinophils,EOS)]、肺功能[用力呼出50%肺活量时的瞬间呼气流量(forced expiratory flow at 50%,FEF50%)、呼气峰值流量(peak expiratory flow,PEF)、第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)、用力肺活量(forced vital capacity,FVC)]。统计学方法采用t检验、χ^(2)检验。结果治疗组经治疗后临床总有效率比参照组高[96.08%(49/51)比82.35%(42/51)](χ^(2)=4.993,P<0.05)。与参照组[(5.23±1.03)d、(4.32±1.30)d、(2.36±0.26)d、(6.22±1.63)d、(5.89±1.07)d]比较,治疗组呼吸困难、咳嗽、喘息、哮鸣音、湿啰音消失时间[(2.25±0.69)d、(2.03±0.85)d、(2.23±0.32)d、(5.63±1.10)d、(3.62±1.04)d]均较短,差异均有统计学意义(t=17.166、10.529、2.252、2.143、10.864,均P<0.05)。治疗1个月后,治疗组血清IL-4、IL-18、IL-1β、EOS水平均比参照组低[(25.30±3.96)ng/L比(28.30±3.47)ng/L,(92.03±7.36)ng/L比(100.65±8.66)ng/L,(2.03±0.26)ng/L比(2.89±0.32)ng/L,(1.06±0.39)%比(2.84±0.52)%],差异均有统计学意义(t=4.069、5.417、14.896、19.557,均P<0.05)。治疗1个月后,治疗组FEF50%、PEF、FEV1、FVC水平均比参照组高,差异均有统计学意义(均P<0.05)。结论重度支气管哮喘急性发作患儿在沙丁胺醇治疗时采用肺部康复训练可使临床效果得到提升,缩短临床呼吸困难、咳嗽等症状消失时间,缓解气道炎症反应,促进患儿肺功能恢复,从而加快患儿康复。

Objective To analyze the effect of lung rehabilitation training on the airway inflammatory factors and lung function in children with severe acute bronchial asthma treated with salbutamol,so as to provide therapeutic basis for clinical treatment of severe acute bronchial asthma.Methods A prospective study was conducted on 102 children with acute attack of severe bronchial asthma who were admitted to the Third Affiliated Hospital of Zhengzhou University from September 2021 to February 2023,and the children were divided into two groups(a reference group and a treatment group)by the random number table method,with 51 cases in each group.In the reference group,there were 32 boys and 19 girls,the age was 5-12(7.32±1.85)years old,the course of disease was 2-18(12.30±1.28)months,and the body weight was 12-27(21.65±2.08)kg.In the treatment group,there were 28 boys and 23 girls,the age was 6-13(7.94±1.16)years old,the course of disease was 2-17(11.89±2.31)months,and the body weight was 11-28(22.32±2.17)kg.After admission,both groups were given anti-infection treatment with budesonide,the reference group was treated with salbutamol,and the treatment group was treated with salbutamol combined with pulmonary rehabilitation training.The treatment cycle of both groups was 1 month.The clinical effects,disappearance time of clinical symptoms(dyspnea,cough,wheezing,wheezing rales,and moist rales),and levels of inflammatory factors[interleukin-4(IL-4),IL-18,IL-1β,and eosinophils(EOS)]and lung function[forced expiratory flow at 50%(FEF50%),peak expiratory flow(PEF),forced expiratory volume in the first second(FEV1),and forced vital capacity(FVC)]before and 1 month after treatment of the two groups were compared.t andχ^(2) tests were applied.Results The total effective rate of the treatment group was higher than that of the reference group[96.08%(49/51)vs.82.35%(42/51)](χ^(2)=4.993,P<0.05).Compared with those in the reference group[(5.23±1.03)d,(4.32±1.30)d,(2.36±0.26)d,(6.22±1.63)d,and(5.89±1.07)d],the duration of dyspnea,cough,wheezing,wheezing rales,and moist rales in the treatment group[(2.25±0.69)d,(2.03±0.85)d,(2.23±0.32)d,(5.63±1.10)d,(3.62±1.04)d]were shorter,with statistically significant differences(t=17.166,10.529,2.252,2.143,and 10.864,all P<0.05).After 1 month of treatment,the levels of serum IL-4,IL-18,IL-1β,and EOS in the treatment group were lower than those in the reference group[(25.30±3.96)ng/L vs.(28.30±3.47)ng/L,(92.03±7.36)ng/L vs.(100.65±8.66)ng/L,(2.03±0.26)ng/L vs.(2.89±0.32)ng/L,(1.06±0.39)%vs.(2.84±0.52)%],with statistically significant differences(t=4.069,5.417,14.896,and 19.557,all P<0.05).After 1 month of treatment,the levels of FEF50%,PEF,FEV1,and FVC in the treatment group were higher than those in the reference group,with statistically significant differences(all P<0.05).Conclusion Lung rehabilitation training can improve the clinical effect,shorten the disappearance time of clinical symptoms such as dyspnea and cough,alleviate the airway inflammation,promote the recovery of lung function,and accelerate the recovery in children with severe bronchial asthma treated with salbutamol in acute stage.