不同雾化吸入方式对婴幼儿毛细支气管炎后反复喘息的临床干预研究
发布时间：2018-07-16 17:18
【摘要】：目的比较空气压缩泵雾化吸入布地奈德混悬液和储雾罐吸入丙酸氟替卡气雾剂干预婴幼儿毛细支气管炎(简称毛支炎)后反复喘息的临床疗效，从而为婴幼儿毛细支气管炎后反复喘息的临床治疗提供一个更安全、经济、有效的方案，同时为减少毛细支气管炎后哮喘的发病进行提前干预。方法选取曾在我科住院并且确诊为毛细支气管炎的婴幼儿，临床症状控制后因反复发作喘息于2011年10月至2012年10月期间在我科哮喘门诊就诊的患儿共120例，入选的患儿在年龄、性别、体重、出生史等方面均无统计学差异，将其分为观察组和对照组；对照组60例，能配合使用储雾罐吸入丙酸氟替卡松气雾剂（辅舒酮，125μg/掀），1掀/次，早晚各1次；病情得到控制者维持治疗3个月后给予降级治疗，剂量为125μg/次，，1次/d；病情未得到控制的的患儿给予升级治疗，可以增加吸入糖皮质激素的剂量或联合白三烯受体拮抗剂（LTRA）；急性发作时吸入辅舒酮症状不能改善的患儿给予口服或静脉糖皮质激素治疗。观察组60例，家庭经济状况较好，家人积极配合使用空气压缩泵，雾化吸入布地奈德混悬液（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维持治疗3个月，进行降级治疗，改为普米克令舒500μg/次，1次/天；未得到控制者给予升级治疗，增加吸入激素剂量或联合LTRA；两组共随访1年。观察治疗后患儿病情的控制程度、喘息再次发作的次数、因急性发作需住院的例数、肺功能的变化以及治疗的费用。结果①吸入性糖皮质激素的早期干预治疗不论是对于毛细支气管炎后喘息发作时的病情缓解，还是对于减少患儿喘息发作的次数及避免日后可能发展为哮喘均有较好的疗效。②两组在控制喘息发作时的病情、减少喘息再发的次数、肺功能的改善方面无统计学差异（P0.05）。③两组在治疗后肺功能指标潮气量（VT/Kg）、呼吸频率（RR）、吸气时间/呼气时间(TI/TE)、达峰时间比（TPEF/TE）、达峰容积比（VPEF/VE）较治疗前明显改善，有统计学差异（P0.05）。④观察组在治疗费用方面明显高于对照组，有统计学差异（P0.05）。结论①吸入性糖皮质激素对毛细支气管炎后反复喘息临床干预疗效明显②潮式呼吸肺功能测定简单、安全、经济，对评估毛细支气管炎后喘息发作的治疗效果、监测病情及预后有较高的价值。③辅舒酮与普米克令舒治疗毛细支气管炎后反复喘息的临床疗效接近,本研究显示普米克令舒的临床治疗费用明显高于辅舒酮，所以辅舒酮的使用更加经济、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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.6
[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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.6
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