CAJ | 학술논문

目的：评价不同的预防方法对婴幼儿毛细支气管炎后反复喘息的预防效果。方法选取2009年1月至2012年1月期间常熟市第一人民医院收治的急性毛细支气管炎患儿201例，将其随机分成4组：氟替卡松组（45例）、孟鲁斯特组（56例）、酮替芬组（49例）、对照组（51例）。通过前瞻性研究具有反复喘息或哮喘高危因素的婴幼儿毛细支气管炎后第一次喘息后予以氟替卡松吸入、孟鲁司特钠、酮替芬口服13周及随后停药观察1年与对照组比较喘息发作情况、喘息时输液及全身糖皮质激素使用情况。结果经过13周干预，氟替卡松组、孟鲁斯特组喘息发作较对照组（P<0.01）及酮替芬组（P<0.05）少，氟替卡松组与孟鲁斯特组、酮替芬组与对照组喘息发作差异无统计学意义（P>0.05）；氟替卡松组、孟鲁斯特组、酮替芬组较对照组静脉输液天数及全身激素使用天数少（P<0.01），孟鲁斯特组尤为明显。干预停止后1年内，氟替卡松组、孟鲁斯特组及酮替芬组与对照组喘息发作差异无统计学意义（P>0.05），但静脉输液天数及全身糖皮质激素使用天数较对照组少（P<0.05），而酮替芬组尤为明显。因为药物副作用7例中断用药，仅占3.03%。结论对于毛细支气管炎后有反复喘息或哮喘高危因素的患儿，予以氟替卡松吸入或孟鲁斯特口服13周，可以减少干预期间的喘息发作及干预期、随后1年观察期喘息时的输液及全身糖皮质激素使用，酮替芬口服13周尽管不能减少干预期间的喘息发作，但能减少干预期及随后1年观察期的喘息时的输液及全身糖皮质激素使用。
목적：평개불동적예방방법대영유인모세지기관염후반복천식적예방효과。방법선취2009년1월지2012년1월기간상숙시제일인민의원수치적급성모세지기관염환인201례，장기수궤분성4조：불체잡송조（45례）、맹로사특조（56례）、동체분조（49례）、대조조（51례）。통과전첨성연구구유반복천식혹효천고위인소적영유인모세지기관염후제일차천식후여이불체잡송흡입、맹로사특납、동체분구복13주급수후정약관찰1년여대조조비교천식발작정황、천식시수액급전신당피질격소사용정황。결과경과13주간예，불체잡송조、맹로사특조천식발작교대조조（P<0.01）급동체분조（P<0.05）소，불체잡송조여맹로사특조、동체분조여대조조천식발작차이무통계학의의（P>0.05）；불체잡송조、맹로사특조、동체분조교대조조정맥수액천수급전신격소사용천수소（P<0.01），맹로사특조우위명현。간예정지후1년내，불체잡송조、맹로사특조급동체분조여대조조천식발작차이무통계학의의（P>0.05），단정맥수액천수급전신당피질격소사용천수교대조조소（P<0.05），이동체분조우위명현。인위약물부작용7례중단용약，부점3.03%。결론대우모세지기관염후유반복천식혹효천고위인소적환인，여이불체잡송흡입혹맹로사특구복13주，가이감소간예기간적천식발작급간예기、수후1년관찰기천식시적수액급전신당피질격소사용，동체분구복13주진관불능감소간예기간적천식발작，단능감소간예기급수후1년관찰기적천식시적수액급전신당피질격소사용。
ObjectiveTo evaluate the effect of different preventative measures on recurrent wheezing after bronchiolitis in infants and young children.MethodsThe infants and young children with high risk of recurrent wheezing or asthma and recovered from bronchiolitis were randomly assigned into four groups: fluticasone group(45 cases), montelukast group(56 cases),ketotifen group(49 cases) and non intervention group(51 cases).Inhaled fluticasone,oral montelukast and oral ketotifen were administered respectively to intervention groups for 13 weeks and the frequency of recurrent wheezing,the days of infusion and usage of systemic corticosteroid during wheezing attacks were observed during the course of medication and subsequent one year.ResultsAfter 13-weeks intervention, the frequency of recurrent wheezing were significant lower in fluticasone group and montelukast group than that in ketotifen group(P<0.05) and in non intervention group(P<0.01) but no significant difference was found between ketotifen group and non intervention group and between fluticasone group and montelukast group(P>0.05). The days of infusion and usage of systemic corticosteroid during wheezing attacks were fewer in fluticasone group, montelukast group and ketotifen group than that in non intervention group (P<0.01),and fewer in montelukast group than that in ketotifen group (P<0.05). During the subsequent one year, no significant difference was found among four groups in the frequency of recurrent wheezing(P>0.05),but there were significant difference between intervention groups and non intervention group in the days of infusion and usage of systemic corticosteroid during wheezing attacks (P<0.05). The treatment were interrupted by side effect in seven children(3.03%). ConclusionThe infants and young children with high risk of recurrent wheezing or asthma and recovered from bronchiolitis administered inhaled fluticasone or oral montelukast for 13 weeks may reduce the frequency of recurrent wheezing during intervention and the days of infusion and usage of systemic corticosteroid during wheezing attacks will be reduced during intervention and the subsequent one year.