联合降阶梯方案治疗婴幼儿喘息疗效及安全性研究

目的    探讨联合降阶梯方案治疗婴幼儿喘息的疗效和安全性。方法    以2010年10 至12月于上海交通大学医学院附属新华医院哮喘专科门诊及普通儿科呼吸门诊就诊的婴幼儿喘息患儿97例作为研究对象，以规范采用联合降阶梯疗法患儿作为治疗组，以仅采用门诊常规治疗的患儿作为对照组（非联合降阶梯疗法组）。两组均采用相同综合性治疗，包括吸氧、退热等对症处理。治疗组口服泼尼松5 mg/d，每天1次，疗程3 d；口服阿奇霉素0.1 g/（kg·d），疗程3 d；每晚用妥洛特罗贴剂1贴（0.5 mg/d），疗程7 d；口服氯雷他定3 mL/d，疗程 14 d；口服孟鲁司特钠4 mg/d，疗程 21 d。对照组采用目前门诊常用治疗方案，包括采用静脉滴注琥珀氢考或甲强龙、平喘药物、抗生素、祛痰止咳合剂、雾化吸入激素等。 结果    治疗组患儿咳嗽、喘息、哮鸣音评分及症状体征消失天数显著低于对照组（P < 0.05），治疗组1个月内复发次数、治疗费用、家长误工天数显著低于对照组（P < 0.05），且治疗组患儿对该方案接受度较高（P < 0.05）。 结论    联合降阶梯疗法应用于婴幼儿喘息疗效肯定，且方便、安全，值得临床应用推广。

A study on efficacy and safety of combine-counter gradient therapy for infants wheezing.

：Objective    To evaluate the efficacy and safety of combine-counter gradient therapy for infants wheezing. Methods    Totally 97 patients from Asthma and General Clinic form October to December 2010，who received combine-counter gradient therapy were chosen as test group，patients with general treatment as control group.The two groups adopted same synthetic therapy，such as oxygen therapy or pyretolysis. The treatment protocol for test group was oral prednisone 5mg/d，3 days；azithromycin 0.1g/（kg·d），3 days； tulobuterol  patch （0.5mg/d），7 days； loratadine 3ml/d，14 days； montelukast 4mg/d，21 days.Control group had antibiotics （primarily cephamycin or azithromycin ）intravenous injection，methylprednisolone， expectorants and inhale corticoids by atomization. Results    Scores of cough， gasping， wheezing rale， recurrence within 1 Month，and charge of therapy and absenteeism rate of parents of test group  were significantly  lower than contol group（P < 0.05）. Moreover， treatment protocols of test group were prone to be more easily accepted（P < 0.05）. Conclusion    Combine-counter gradient therapy for infants wheezing is effective，convenient and safe，which deserves clinical application.