吸入性糖皮质激素对婴幼儿重症肺炎患儿潮气呼吸肺功能的影响

目的观察及探讨吸入性糖皮质激素治疗对婴幼儿重症肺炎患儿潮气呼吸肺功能的影响及意义。方法选择该院儿科重症监护病房（PICU）2012年6月至2013年6月收治的婴幼儿重症肺炎患儿80例,年龄1-35个月,分为A、B组各40例。两组患儿均给予常规吸氧、抗感染对症支持等综合治疗,A组在综合治疗基础上于住院时以及出院后加用布地奈德混悬液（500μg,每天2次）吸入治疗,疗程3个月。另选择38例无呼吸系统疾病健康婴幼儿作为健康对照组（C组）,其中男20例,女18例,平均月龄（18.1±0.7）个月。分别测定入院时、临床治愈时及出院后3个月三组患儿的潮气呼吸肺功能主要测定参数：潮气量（VT）、呼吸频率（RR）、吸气时间（TI）、呼气时间（TE）、吸呼比（TI/TE）、达峰时间比（TPTEF/TE）及达峰容积比（VPTEF/VE）。观察各组患儿肺功能指标变化及改善率的差异。结果入院时A、B组分别与C组比较,RR增快、TI缩短、TE缩短、TI/TE、TPTEF/TE、VPTEF/VE及VT明显降低,差异均有统计学意义（P〈0.05）;临床治愈时A、B组VT增加,RR下降,与入院时比较,差异有统计学意义（P〈0.05）,两组TPEF/TE、VPEF/VE指标较治疗前增高,且A组改善明显优于B组,差异均有统计学意义（P〈0.05）,但两组仍明显低于C组,差异均有统计学意义（P〈0.05）,A组TPEF/TE、VPEF/VE较B组明显增高,差异有统计学意义（P〈0.05）;出院后3个月A、B组RR、VT、TI、TE、TI/TE均与C组相当,A组TPTEF/TE、TPTEF/VE指标进一步改善,其水平与C组相当,且显著优于B组,差异有统计学意义（P〈0.05）;B组TPEF/TE、VPEF/VE仍显著低于C组,差异均有统计学意义（P〈0.05）。结论婴幼儿重症肺炎患儿潮气呼吸肺功能明显受损,临床症状缓解后其肺功能损害仍持续存在,吸入性糖皮质激素治疗可改善其肺功能损害。

The effects of inhaled corticosteroids on tidal breathing lung function of infants with severe pneumonia

Objective To observe the influence and significance of inhaled corticosteroids on tidal breathing lung function of infants with severe pneumonia. Methods Totally 80 infants with severe pneumonia aged 1-35 months,who were in Pediatric Intensive Care Unit（PICU） of Maternal and Child Hospital of Hubei Province from June 2012 to June 2013,were selected and randomized into group A and group B,40 cases in each group. The patients in both groups were given comprehensive treatment of conventional oxygen inhalation,anti-infection,symptomatic treatment and so on,while group A was added with budesonide sus pension（500 μg,twice daily） for inhalation therapy when admitted and discharged from the hospital with the treatment course of three months. Another 38 infants without respiratory diseases were taken as the healthy control group（group C）. To measure the tidal breathing lung functions in the three groups at pre-treatment,clinical cured and 3 months after discharging from hospital respectively mainly including：tidal volume（VT）,respiratory rate（RR）,inspiration time（TI）,expiratory time（TE）,inspiration to expiratory ratio（TI/TE）,time to peak ratio（TPTEF/TE） and peak volume ratio（VPTEF/VE）. To observe the change of infants′ lung functional parameter and improvement rate in all the groups. Results Compared with the group C on admission,the RR in group A and group B increased,TI and TE shortened,TI/TE,TPTEF/TE,VPTEF/VE and VT reduced obviously,and difference of each index had statistical significance（P〈0.05）;the VT in the group A and group B increased and RR reduced when clinical cured, comparing with the VT and RR on admission,the difference was statistically significant（P〈0.05）;the TPTEF/TE and VPTEF/VE after treatment were higher than those before treatment,and the group A improved were significantly than the group B（P〈0.05）,but which were significantly lower than those in group C（P〈0.05）;the TPEF/TE and VPEF/VE of group A were obviously higher than those of