目的 探讨丙酸倍氯米松雾化治疗毛细支气管炎患儿的疗效及安全性.方法 选取2014年12月—2015年3月河北省儿童医院呼吸一科、河北医科大学第三医院儿科收治的毛细支气管炎患儿150例,将患儿按照随机分组表先后顺序分为对照组(n=70)和试验组(n=80).对照组给予0.9%氯化钠溶液1 ml+复方异丙托溴铵1.25 ml,试验组给予丙酸倍氯米松0.4 mg(1 ml)+复方异丙托溴铵1.25 ml,两组均雾化治疗2次/d,连用5 d.记录两组住院时、6 h、12 h、24 h、48 h、72 h、96 h临床病情严重程度评分;治疗前及治疗5 d后达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、呼出气一氧化氮(FeNO)水平.并观察两组不良反应发生情况.结果 治疗方法与时间对临床病情严重程度评分存在交互作用(F交互=7.983,P<0.001),且二者对临床病情严重程度评分的主效应显著(F组间=26.929,P<0.001;F时间=553.770,P<0.001).治疗后,试验组TPTEF/TE、VPEF/VE高于对照组,FeNO低于对照组(P<0.05).对照组治疗后TPTEF/TE、FeNO高于治疗前,试验组治疗后TPTEF/TE、VPEF/VE、FeNO均高于治疗前(P<0.05).治疗过程中两组均无咳嗽、气管痉挛、咽喉部不适、肌肉震颤、鹅口疮、声音嘶哑等不良反应发生.结论 对毛细支气管炎患儿在常规治疗的基础上加用丙酸倍氯米松可更快地缓解患儿急性发作症状,改善小气管功能,无激素相关的不良反应发生.%Objective To study the efficacy and safety of nebulized beclomethasone on capillary bronchitis in children. Methods We enrolled 150 children with capillary bronchitis who received inpatient treatment in Department of No. 1 Respiratory,Children′ s Hospital of Hebei Province and Department of Pediatrics,the Third Hospital of Hebei Medical University from December 2014 to March 2015 and divided them into the control group (n = 70)and the experimental group (n= 80)in accordance with the random number table. The control group received nebulized 0. 9% sodium chloride solution (1 ml)combined with compound ipratropium bromide (1. 25 ml),and the experimental group received nebulized 0. 4 mg (1 ml) beclomethasone combined with compound ipratropium bromide (1. 25 ml),twice daily,for 5 days successively. The clinical symptom scores were assessed on admission,at 6 h,12 h,24 h,48 h,72 h and 96 h after admission. The values of TPTEF/TE,VPEF/ VE and FeNO were measured before treatment and 5 days after treatment. The adverse reactions of the two groups during treatment were observed. Results The treatment regimen and duration had an interactive effect on the bronchitis severity score (F interaction = 7. 983,P < 0. 001). Moreover,the main effects produced by treatment regimen on the bronchitis severity scores were significant (F group = 26. 929,P < 0. 001). Treatment duration exerted obvious main effects on the bronchitis severity scores (F time = 553. 770,P < 0. 001). After treatment,the values of TPTEF/ TE and VPEF/ VE were higher but value of FeNO was lower in the experimental group compared with the control group (P < 0. 05). The values of TPTEF/ TE and FeNO were increased in the control group after treatment (P < 0. 05). The values of TPTEF/ TE,VPEF/ VE and FeNO were all elevated in the experimental group after treatment (P < 0. 05). There were no cough,tracheal spasm,throat discomfort,muscle tremor, thrush,hoarseness and other adverse reactions in both groups during treatment. Conclusion Nebulized beclomethasone combined with the conventional treatment can faster improve the symptoms of acute attack of capillary bronchitis and the functions of small airway without hormone-related adverse reactions.
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