【摘要】：目的比較空氣壓縮泵霧化吸入布地奈德混懸液和儲(chǔ)霧罐吸入丙酸氟替卡氣霧劑干預(yù)嬰幼兒毛細(xì)支氣管炎(簡(jiǎn)稱毛支炎)后反復(fù)喘息的臨床療效，從而為嬰幼兒毛細(xì)支氣管炎后反復(fù)喘息的臨床治療提供一個(gè)更安全、經(jīng)濟(jì)、有效的方案，同時(shí)為減少毛細(xì)支氣管炎后哮喘的發(fā)病進(jìn)行提前干預(yù)。方法選取曾在我科住院并且確診為毛細(xì)支氣管炎的嬰幼兒，臨床癥狀控制后因反復(fù)發(fā)作喘息于2011年10月至2012年10月期間在我科哮喘門診就診的患兒共120例，入選的患兒在年齡、性別、體重、出生史等方面均無(wú)統(tǒng)計(jì)學(xué)差異，將其分為觀察組和對(duì)照組；對(duì)照組60例，能配合使用儲(chǔ)霧罐吸入丙酸氟替卡松氣霧劑（輔舒酮，125μg/掀），1掀/次，早晚各1次；病情得到控制者維持治療3個(gè)月后給予降級(jí)治療，劑量為125μg/次，，1次/d；病情未得到控制的的患兒給予升級(jí)治療，可以增加吸入糖皮質(zhì)激素的劑量或聯(lián)合白三烯受體拮抗劑（LTRA）；急性發(fā)作時(shí)吸入輔舒酮癥狀不能改善的患兒給予口服或靜脈糖皮質(zhì)激素治療。觀察組60例，家庭經(jīng)濟(jì)狀況較好，家人積極配合使用空氣壓縮泵，霧化吸入布地奈德混懸液（普米克令舒）500μg/次，早晚各1次；病情完全控制，肺功能值接近正常者維持治療3個(gè)月，進(jìn)行降級(jí)治療，改為普米克令舒500μg/次，1次/天；未得到控制者給予升級(jí)治療，增加吸入激素劑量或聯(lián)合LTRA；兩組共隨訪1年。觀察治療后患兒病情的控制程度、喘息再次發(fā)作的次數(shù)、因急性發(fā)作需住院的例數(shù)、肺功能的變化以及治療的費(fèi)用。結(jié)果①吸入性糖皮質(zhì)激素的早期干預(yù)治療不論是對(duì)于毛細(xì)支氣管炎后喘息發(fā)作時(shí)的病情緩解，還是對(duì)于減少患兒喘息發(fā)作的次數(shù)及避免日后可能發(fā)展為哮喘均有較好的療效。②兩組在控制喘息發(fā)作時(shí)的病情、減少喘息再發(fā)的次數(shù)、肺功能的改善方面無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。③兩組在治療后肺功能指標(biāo)潮氣量（VT/Kg）、呼吸頻率（RR）、吸氣時(shí)間/呼氣時(shí)間(TI/TE)、達(dá)峰時(shí)間比（TPEF/TE）、達(dá)峰容積比（VPEF/VE）較治療前明顯改善，有統(tǒng)計(jì)學(xué)差異（P0.05）。④觀察組在治療費(fèi)用方面明顯高于對(duì)照組，有統(tǒng)計(jì)學(xué)差異（P0.05）。結(jié)論①吸入性糖皮質(zhì)激素對(duì)毛細(xì)支氣管炎后反復(fù)喘息臨床干預(yù)療效明顯②潮式呼吸肺功能測(cè)定簡(jiǎn)單、安全、經(jīng)濟(jì)，對(duì)評(píng)估毛細(xì)支氣管炎后喘息發(fā)作的治療效果、監(jiān)測(cè)病情及預(yù)后有較高的價(jià)值。③輔舒酮與普米克令舒治療毛細(xì)支氣管炎后反復(fù)喘息的臨床療效接近,本研究顯示普米克令舒的臨床治療費(fèi)用明顯高于輔舒酮，所以輔舒酮的使用更加經(jīng)濟(jì)、方便。
[Abstract]:Objective to compare the clinical effects of inhaling budesonide suspension with air compression pump and inhaling flutica propionate aerosol in treating infant bronchiolitis (infantile bronchiolitis) with repeated wheezing. It provides a more safe, economical and effective scheme for the clinical treatment of recurrent wheezing after bronchiolitis in infants and early intervention to reduce the incidence of asthma after bronchiolitis. Methods A total of 120 infants who were hospitalized in our department and diagnosed with bronchiolitis were enrolled in this study. 120 children with recurrent wheezing from October 2011 to October 2012 were enrolled in this study. There were no statistical differences in sex, body weight, birth history, etc. They were divided into observation group and control group, the control group (n = 60) was able to inhale fluticasone propionate aerosol (fluticasone propionate 125 渭 g / kg) once a time in the morning and evening, and 60 cases in the control group. The patients with controlled condition were treated with downgrade therapy at a dose of 125 渭 g / time once a day after maintenance therapy for 3 months, and those patients with uncontrolled condition were given upgraded treatment, which could increase the dose of inhaled glucocorticoid or combined with leukotriene receptor antagonist (LTRA). Children who had no improvement in the symptoms of inhaling cosulone during acute attack were treated with oral or intravenous glucocorticoids. In the observation group, 60 cases were in good economic condition. The family actively cooperated with the use of air compression pump and inhaled budesonide suspension (Pulmicort) 500 渭 g / time, once in the morning and once in the morning, and the disease was completely controlled. Patients with close to normal pulmonary function were treated with continuous treatment for 3 months, and treated with demotion treatment, which was replaced by Pulmicort 500 渭 g / time once a day; those who were not controlled were given upgrade therapy to increase the dose of inhaled hormone or combined with LTRA. the two groups were followed up for one year. The degree of disease control, the number of times of recurrent wheezing, the number of hospitalization for acute attack, the changes of lung function and the cost of treatment were observed. Results 1the early intervention of inhaled glucocorticoid was not only for the remission of asthma after bronchiolitis, but also for the treatment of inhaled glucocorticoid. There was also a better effect on reducing the frequency of wheezing attack in children and avoiding the possibility of developing asthma in the future. 2 the two groups had better curative effect in controlling the condition of wheezing attack and reducing the frequency of recurrent wheezing. There was no significant difference in the improvement of pulmonary function between the two groups (P0.05). After treatment, the pulmonary function indexes such as tidal volume (VT / Kg), respiratory rate (RR), inspiratory time / exhalation time (tie / TE), peak time ratio (TPEF / TE), peak volume ratio (VPEF / VE) were significantly improved after treatment. There was statistical difference (P0.05). 4 the treatment cost in the observation group was significantly higher than that in the control group (P0.05). Conclusion (1) the therapeutic effect of inhaled glucocorticoid on recurrent wheezing after bronchiolitis is obvious. 2 the measurement of respiratory and pulmonary function of tidal breathing is simple, safe and economical. The therapeutic effect of inhaled glucocorticoid on evaluating the wheezing attack after bronchiolitis is obvious. The value of monitoring the state of illness and prognosis was higher than that of Pulmicort. 3. The clinical efficacy of Pulmicort was similar to that of Pulmicort in the treatment of recurrent wheezing after bronchiolitis. This study showed that the clinical treatment cost of Pulmicort was significantly higher than that of cosuxone. So the use of cosolone is more economical and convenient.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R725.6

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