雾化吸人高剂量糖皮质激素对儿童中重度支气管哮喘急性发作的疗效被引量：77

The efficacy of nebulized budesonide in acute moderate to severe exacerbations of asthma in children

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摘要目的观察吸人糖皮质激素（ics）对儿童中～重度哮喘急性发作的疗效，探讨更有效、安全的儿童哮喘急性发作治疗方案。方法采用前瞻性、随机、双盲、安慰剂平行对照研究方法，将40例5-15岁（男30例，女10例）因哮喘急性发作急诊的儿童按随机数字表法随机分为吸入激素组（21例）和常规治疗组（19例），分别以氧动雾化吸人法吸人0．5％沙丁胺醇（150μg／kg）＋0．025％溴化异丙托品（1m1）＋0．05％布地奈德（2m1）或0．5％沙丁胺醇（150g／kg）＋0．025％溴化异丙托品（1m1）＋生理盐水（2m1），每30分钟雾化吸入1次，连用3次。治疗前、刚完成3次雾化吸入后（治疗后0h）、完成后1h（治疗后1h）、完成后2h（治疗后2h）分别测定肺通气功能、一tL,率（HR）、呼吸频率（Rlq_）、经皮测SaO：，进行临床计分（CS）。结果吸入激素组和常规治疗组治疗后CS、RR、SaO2、FEV1、FEV，占预计值％（FEV。％）均较治疗前明显改善（均P〈0．05），HR治疗前后比较差异无统计学意义（均P〉0．05）。治疗后2h吸入激素组和常规治疗组CS[中位数（四分位间距）]分别为0（0）分和0（1）分，吸入激素组明显低于常规治疗组（z=2．522，P=0．012）。两组问治疗前后RR、HR和SaO：比较差异均无统计学意义（均P〉0．05）。吸入激素组治疗后第1小时和第2小时FEV，占预计值％分别改善8．0％（6．8％）和5．5％（6．5％），常规治疗组分别改善6．0％（8．5％）和1．0％（6．5％），吸入激素组治疗后第2小时FEV，改善0．07（0．12）L，常规治疗组为0．01（0．10）L，两组间比较差异均有统计学意义（z值分别为2．270、2．686和2．455，均P〈0．05）。吸入激素组治疗后2h完全缓解率为85．0％（17／20），明显高于常规治疗组的50．o％（9／18），差异有统计学意义（∥=5．371，P=0．024）。吸入激素组和常规治疗组需要全身用糖皮质激素的比率分别为15．0％（3／20）和44．4％（8／18），两组问比较差异有统计学意义（X2=3．993，P=0．046）。吸人激素组仅5％（1／20）患儿需住院治疗，而常规治疗组17％（3／18）患儿需住院治疗。结论中～重度哮喘急性发作时，高剂量、短时间间隔雾化吸入布地奈德能与吸入速效支气管舒张剂发挥协同作用，快速有效缓解哮喘急性发作症状，改善肺功能，减少全身用糖皮质激素使用，降低住院率，在非危及生命哮喘急性发作可替代或部分替代全身用糖皮质激素。 [ Abstract] Objective To evaluate the effect of nebulized budesonide （BUD） in acute moderate to severe exacerbations of asthma in children. Methods Forty children, 5 to 15 years of age, with acute moderate to severe attacks of asthma, were randomized into BUD group and control group, receiving nebulized 0. 5% salbutamol （ 150 μg/kg）＋ 0. 025% ipratropium bromide （ 1 ml）＋ 0. 05% budesonide （ 2 ml ） or nebulized 0. 5 % salbutamol （ 150 Ixg/kg）＋ 0. 025 % ipratropium bromide （ 1 ml）＋ saline （ 2 ml） at half-hourly intervals for 3 doses respectively. Lung function, respiratory rate （ RR）, heart rate （ HR）, oxygen saturation（ SaO2 ） and clinical score（CS） were monitored. Results The baseline characteristics of the 2 groups were similar. After 3 doses of nebulization, CS, RR, SaO2, FEV1 and FEVI% weresignificantly improved in both groups（ P 〈0.05）. The CS in BUD group was significantly lower than that in control group at the end of 2 h after the third dose of nebulization 0 （0） vs 0 （ 1 ）, Z = 2. 522, P = 0. 012. There were no significant differences in RR, HR and SaO2 between 2 groups（P 〉 O. 05 ）. The improvement of FEV1% in the first hour and the second hour after 3 doses of nebulization was 8.0 （ 6. 8 ） % and 5.5 （6. 5） % in BUD group, and 6. 0 （ 8. 5 ） % and 1.0 （ 6. 5 ） % in control group, the improvement in BUD group being significantly greater than that in control group （ Z = 2. 270 and 2. 686, P = 0, 023 and 0. 007 respectively）. The improvement of FE^1 in the second hour after 3 doses of nebulization was significantly greater in BUD group than in control group 0. 07（0. 12）L vs O. 01 （0. 10）L, Z =2. 455, P =0. 014. The full recovery rate in BUD group at the end of 2 h after completion of nebulization was significantly higher than that in control group（ 17/20, 85.0% vs 9/18, 50. 0% , X2 = 5. 371 ,P = 0. 024）. The proportion of patients who needed to use oral corticosteroids was significantly lower in BUD group than in control group （3/20, 15.0% vs 8/18, 44.4% , X2 =3. 993 ,P 〈0. 046）. The hospitalization rate was 5% （1/20） in BUD group, and 17% （3/18） in control group, but the difference was not statistically significant （P 〉0. 05 ）. Conclusion Nebulized BUD in high dose and at short intervals combined with rapid-acting bronchodilators has an additional bronchodilator response, associated with more rapid and better improvement in clinical symptoms and lung function, indicating that it is preferred in the early management of acute moderate to severe exacerbation of asthma in children.