CAJ | 학술논문

目的观察不同起始剂量布地奈德混悬液雾化吸入(budesonide inhalation,BI)治疗婴幼儿中重度哮喘急性发作的疗效和安全性.方法 2008年9月至2010年4月,上海交通大学附属第一人民医院儿内科、上海交通大学医学院附属新华医院儿内科及复旦大学附属儿科医院呼吸科共收集6个月～3岁的中重度哮喘急性发作的住院患儿150例,随机分为高起始剂量BI组和常规起始剂量BI组.高起始剂量BI组给予雾化吸入BI 1 mg/次,每8小时1次,连用2d.常规起始剂量BI组给予雾化吸入BI 0.5 mg/次,每8小时1次,连用4 d.两组均按需给予博利康尼雾化吸入2.5 mg/次.主要疗效指标为入院时(0 h)及入院后8、16、24、48、72 h的临床症状评分;次要疗效指标为β2受体激动剂、全身糖皮质激素使用情况、住院总天数及医疗费用.结果采用 SPSS 13.0统计软件进行分析.结果 (1)两组组内治疗后各时间点的临床症状评分与入院时比较均明显降低,差异有统计学意义(P＜0.05);高起始剂量BI组较常规起始剂量B1组在治疗后8h、16h能更快地改善症状,提高临床症状评分(2.87±1.60 vs4.48 ±2.24,2.48±1.56 vs 3.25±1.82)(P＜0.01).(2)高起始剂量BI组特布他林的使用量、全身激素的累积使用量均明显减少[(16.27±12.99) mg vs (22.90±18.27) mg,(4.54±18.18) mg vs (11.16±21.34) mg](P＜0.05);而平均住院天数、住院总费用两组比较差异无统计学意义(P＞0.05).(3)全部受试对象未见鹅口疮、声音嘶哑等与吸入激素相关的不良反应.结论对于中重度哮喘急性发作的婴幼儿,高起始剂量BI治疗能更快地控制症状,减少全身激素的使用量,具备较好的安全性,值得临床推广.
목적 관찰불동기시제량포지내덕혼현액무화흡입(budesonide inhalation,BI)치료영유인중중도효천급성발작적료효화안전성.방법 2008년9월지2010년4월,상해교통대학부속제일인민의원인내과、상해교통대학의학원부속신화의원인내과급복단대학부속인과의원호흡과공수집6개월～3세적중중도효천급성발작적주원환인150례,수궤분위고기시제량BI조화상규기시제량BI조.고기시제량BI조급여무화흡입BI 1 mg/차,매8소시1차,련용2d.상규기시제량BI조급여무화흡입BI 0.5 mg/차,매8소시1차,련용4 d.량조균안수급여박리강니무화흡입2.5 mg/차.주요료효지표위입원시(0 h)급입원후8、16、24、48、72 h적림상증상평분;차요료효지표위β2수체격동제、전신당피질격소사용정황、주원총천수급의료비용.결과채용 SPSS 13.0통계연건진행분석.결과 (1)량조조내치료후각시간점적림상증상평분여입원시비교균명현강저,차이유통계학의의(P＜0.05);고기시제량BI조교상규기시제량B1조재치료후8h、16h능경쾌지개선증상,제고림상증상평분(2.87±1.60 vs4.48 ±2.24,2.48±1.56 vs 3.25±1.82)(P＜0.01).(2)고기시제량BI조특포타림적사용량、전신격소적루적사용량균명현감소[(16.27±12.99) mg vs (22.90±18.27) mg,(4.54±18.18) mg vs (11.16±21.34) mg](P＜0.05);이평균주원천수、주원총비용량조비교차이무통계학의의(P＞0.05).(3)전부수시대상미견아구창、성음시아등여흡입격소상관적불량반응.결론 대우중중도효천급성발작적영유인,고기시제량BI치료능경쾌지공제증상,감소전신격소적사용량,구비교호적안전성,치득림상추엄.
Objective To observe the efficacy and safety of different initial doses of nebulized budesonide inhalation (BI) in infants and young children with moderate to severe asthma exacerbations.Methods A multi-center,parallel controlled clinical trial was performed during Sep 2008 to Apr 2010 in three hospitals,which were Department of Pediatrics,Shanghai Jiaotong University Affiliated Shanghai First People's Hospital,Department of Pediatrics,Shanghai Jiaotong University School of Medicine Affiliated Xinhua Hospital,and Department of Respiratory,Fudan University Affiliated Children's Hospital.One hundred and fifty children aged 6 to 36 month with moderate to severe asthma exacerbations were randomly divided into two groups.The high-starting-dose group was treated with a dose of 1 mg nebulized BI every 8 h for 2 days,while the conventional-starting-dose group was treated with a dose of 0.5 mg cvcry 8 h for 4 days.The terbutaline sulfate aerosol liquid was administered with a dose of 2.5 mg each time as needed.The primary outcome measures were severity scores,which were assessed at admission (0 h),and 8 h,16 h,24 h,48 h,72 h after treatment separately.The secondary outcome measures included the use of β2 receptor agonist,the systemic use of corticosteroids,average length of hospital stay and total cost.The data was analyzed with SPSS 13.0.Results (1) The clinical severity scores were significantly decreased at all time points after treatment in both groups (P ＜ 0.05).Compared with conventional starting-dose of BI,high starting-dose of 3.25 ± 1.82,P ＜ 0.01).(2) The terbutaline doses and the systemic corticosteroids do-ses were significantly reduced in high-starting-dose group compared with conventional-starting-dose group [(16.27 ± 12.99) mg vs (22.90 ± 18.27) mg,P ＜ 0.05 ; (4.54 ± 18.18) mg vs (11.16 ± 21.34) mg,P ＜ 0.05).The average length of hospital stay and the total cost of the two groups showed no significant differences (P ＞ 0.05).(3) There were no side effects associated with BI.Conclusion Compared with conventional treatment,high-starting-dose of BI can control symptoms fast and reduce the use of systemic corticosteroid without any side effects.BI improved symptoms more quickly at 8 h (2.87 ± 1.60 vs 4.48 ± 2.24,P ＜ 0.01) and 16 h (2.48 ± 1.56 vs