雾化吸入疗法对1—6个月婴儿急性毛细支气管炎的利弊分析——附305例报告

目的：分析雾化吸入疗法（AIT）对1～6个月婴儿急性毛细支气管炎的利弊。方法：将305例急性毛细支气管炎患儿按随机数表法分为雾化组166例和对照组139例，两组综合治疗方案按临床路径执行，雾化组给予布地奈德混悬液氧气驱动雾化吸入。每次0．5—1mg，每日3～4次，每次10min，对照组不用雾化吸入疗法，评价临床疗效及住院治疗第一个24h内惠儿喘憋、肺部哆音情况，观察治疗过程中喘憋消失时间、肺部哆音消失时间、需要吸氧例数及其平均吸氧时间。结果：在住院治疗第一个24h内，雾化组喘憋加重46例（27．71％），肺部哆音加重59例（35．54％）；对照组喘憋加重21例（15．1l％），肺部哆音加重16例（11．51％），两组比较差异有统计学意义（P〈0．01）。需要吸氧例数雾化组51例（30．72％），对照组43例（30．93％），两组比较差异无统计学意义（P〉0．05）；平均吸氧时间雾化组（2．39±0．72）d，对照组（2．41±0．69）d，两组比较差异无统计学意义（P〉0．05）；需要机械通气的例数雾化组9例（5．42％），对照组4例（2．88％），两组比较差异无统计学意义（P〉0．05）；喘憋消失时间雾化组（2．79＋0．81）d，对照组（3．01±1．01）d，两组比较差异有统计学意义（P〈0．05）；哆音消失时间雾化组（7．58±1．83）d，对照组（6．07±1．62）d，两组比较差异有统计学意义（P〈0．01）；有效率雾化组57．83％，对照组56．1I％，两组比较差异无统计学意义（P〉0．05）；住院时间雾化组（6．56±2．01）d，对照组（6．17±2．12）d，两组比较差异无统计学意义（P〉0．05）。结论：AIT可以减轻急性毛细支气管炎患儿的临床症状，但不能缩短病程；小婴儿和重症患儿要注意治疗初期的治疗矛盾现象及治疗后期所引起的痰液不易消失情况；呼吸困难缓解后应及时停用，过度应用有害无益。

Advantages and Disadvantages of Atomization Inhalation Therapy for Infants Aged 1-6 Months with Bronchiolitis. A Report of 305 Cases

Objective： To analyze the advantages and disadvantages of atomization inhalation in the treatment of bronchiolitis in infants aged 1 - 6 months. Methods. According to the order of admission, 305 cases of infants with bronchiolitis were randomly divided into an atomization group （n = 166 cases） and a control group （n = 139 cases）. Two groups received comprehensive treatment according to the clinical path execution. The atomization group was given budesonide by atomizing inhalation with oxygen-driven, every time 0.5 - 1 mg, 3 - 4 times per day, each time lasts 10 minutes. The control group did not receive inhalation therapy. The clinical curative effect, wheezing and pulmonary rales within the first twenty-four hours of hospitalization were evaluated. The disappearance time of wheezing and pulmonary rales, the number of patients needing oxygen supplement and the average course of oxygen therapy were observed. Results： In the first twenty-four hours of hospitalization, wheezing and pulmonary rales were aggravated in 46 cases （27.71%） and 59 cases （35.54%） in the atomization group respectively; in the control group, they were in 21 cases （15. 11% ） and 16 cases （11.51% ） ; there was a significant difference between the two groups （P〈0.01）. The numbers of cases required oxygen were 51 cases in the atomization group （30.72%） and 43 cases in the control group （30.93 % ） ; there was no significant difference （P〉0.05）. The average length of oxygen inhalation in the atomization group was （2.39-±0.72） days, while in the control group it was （2.41 ±0.69） days; the two groups had no significant difference （P〉0.05）. There were 9 cases （5.42%） in the atomization group and 4 cases （2.88%） in the control group receiving mechanical ventilation; the two groups had no significant difference （P〉0.05）. The disappearance time of wheezing were （2.79±0.81） days in the atomization group and （3.01 ±1.01 ） days in the control group; there was no significant difference （P〈0.05）. The disappearance time of rales were （7.58± 1.83 ） days in the atomization group and （6.07-± 1.62 ） days in the control group; there was a significant difference between the two groups （P〈0.01）. The effective rate of the atomization group was 57.83%, while it was 56.11% in the control group ; there was no significant difference （ P〉0. 05 ）. The length of hospitalization in the atomization group was （6.56±2.01） days, while in the control group it was （6.17±2.12） days; there was no significant difference （P〉0.05）. Conclusions： Atomization inhalation therapy can reduce clinical symptoms in infants with bronchiolitis, but it cannot shorten the course. Clinicians should pay attention to the therapeutic paradox during early treatment and sputum retention at the end of the treatment period in infants and children with severe bronchiolitis. It should be deactivated after dyspnea remission; overuse makes things worse.