高、低剂量布地奈德混悬液雾化吸入治疗小儿毛细支气管炎的对比研究

doi:10.3877/cma.j.issn.1673-5250.2013.01.013

目的

探讨高、低剂量布地奈德(BUD)混悬液雾化吸入治疗小儿毛细支气管炎的临床疗效、住院时间及费用。

方法

选择2011年1月至12月在本院初诊为毛细支气管炎并住院治疗的157例患儿为研究对象。对其按照入院顺序分为低剂量组(n＝78)与高剂量组( n＝79)，分别采取雾化吸入BUD混悬液0.5 mg/次与1.0 mg/次治疗。对两组接受雾化吸入治疗患儿的临床疗效、住院时间及费用进行统计学处理(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与其签署临床研究知情同意书)。两组患儿的年龄、性别及小儿毛细支气管炎分型等比较，差异无统计学意义(P>0.05)。

结果

高剂量组患儿在接受BUD混悬液雾化治疗30 min与60 min时的Beck临床评分、呼吸频率均较低剂量组降低更显著，差异均有统计学意义(P<0.01)；而血氧饱和度则较低剂量组显著升高，差异有统计学意义(P<0.01)；高剂量组患儿的平均住院时间及平均住院费用显著低于低剂量组，差异均有统计学意义(P<0.01)；两组患儿均无明显不良反应发生。

结论

采用1.0 mg/次雾化吸入BUD混悬液治疗小儿毛细支气管炎较采用0.5 mg/次更能显著降低患儿在吸入治疗30 min，60 min时Beck临床评分及呼吸频率，改善患儿血氧饱和度，并缩短患儿的住院时间，降低住院费用。雾化吸入BUD治疗对患儿无明显不良反应。

关键词: 毛细支气管炎, 布地奈德混悬液, 剂量, 临床疗效, 儿童

Objective

To evaluate the clinical features of children with bronchiolitis, and compared their treatment response between different dosage of nebulised budesonide suspension for inhalation.

Methods

From January to December 2011, a total of 157 cases of children with bronchiolitis were recruited. Related clinical data of children diagnosed and administrated were collected and analyzed by soft ware SPSS 19.0. The patients were randomly divided into low dose group(n=78) and high dose group(n=79), they were nebulised budesonide suspension for inhalation 0.5 mg once and 1.0 mg once, respectively. Informed consent was obtained from the parents of each participating child. There had no significance difference between two groups among age, gender ratio and classified of bronchiolitis evaluated(P>0.05).

Results

At treatment 30 minutes, children with mild bronchiolitis, Beck score, respiratory frequency in high dose group were much lower than those in low dose group(P<0.001, P=0.01), pulse oxygen saturation in high dose group was statistically higher than that in low dose group(t=3.596, P<0.001). The same result could be seen in children with severe bronchiolitis. At treatment 60 minutes, children with mild bronchiolitis, Beck score, respiratory frequency in high dose group were much lower than those in low dose group(P=0.003, P=0.001), pulse oxygen saturation in high dose group was much higher than that in low dose group(t=4.593, P<0.001), The same result could be seen in children with severe bronchiolitis. There had no significance difference between high and low dose group in hospitalization time and expenses (P<0.05), and those in high dose group were much shorter and less cost.

Conclusions

Treatment by 1.0 mg budesonide suspension, response of children with bronchiolitis are much better than that of 0.5 mg group. Related clinical data include faster changing in Beck clinical score, respiratory frequency, pulse oxygen saturation; shorter hospitalization time and less cost of hospitalization expenses.

Key words: bronchiolitis, budesonide suspension, dosage, clinical effect, child

图1 小儿毛细支气管炎发病的好发季节比较

Figure 1 Comparison of seasonal occurrence rate of bronchiolitis

表1 两组患儿治疗前及接受0.5 mg与1.0 mg雾化吸入治疗30 min，60 min时的Beck评分比较(分，±s)

Table 1 Comparison of Beck score between two groups at admission, and treatment 30 min, 60 min (score，±s)

组别		n	治疗前	30 min时	60 min时
重度患儿		?	?	?	?
?	高剂量组	26	10.35±2.14	8.63±1.52^a	7.63±0.52^a
?	低剂量组	24	10.23±2.17	9.56±1.75^b	8.72±0.74^a
?	t	?	－0.198	2.040	7.042
?	P	?	0.844	0.047	<0.001
轻度患儿		?	?	?	?
?	高剂量组	53	5.65±1.28	5.02±0.21^a	4.81±0.41^a
?	低剂量组	54	5.72±1.21	5.18±0.36^a	5.02±0.53^a
?	t	?	0.861	4.293	3.069
?	P	?	0.391	<0.001	0.003

表1 两组患儿治疗前及接受0.5 mg与1.0 mg雾化吸入治疗30 min，60 min时的Beck评分比较(分，±s)

Table 1 Comparison of Beck score between two groups at admission, and treatment 30 min, 60 min (score，±s)

组别		n	治疗前	30 min时	60 min时
重度患儿		?	?	?	?
?	高剂量组	26	10.35±2.14	8.63±1.52^a	7.63±0.52^a
?	低剂量组	24	10.23±2.17	9.56±1.75^b	8.72±0.74^a
?	t	?	－0.198	2.040	7.042
?	P	?	0.844	0.047	<0.001
轻度患儿		?	?	?	?
?	高剂量组	53	5.65±1.28	5.02±0.21^a	4.81±0.41^a
?	低剂量组	54	5.72±1.21	5.18±0.36^a	5.02±0.53^a
?	t	?	0.861	4.293	3.069
?	P	?	0.391	<0.001	0.003

表2 两组患儿治疗前及接受雾化吸入治疗30 min，60 min时的呼吸频率比较(次/min，±s)

Table 2 Comparison of respiratory rate between two groups at admission, and treatment 30 min, 60 min (/min，±s)

组别		n	治疗前	30 min时	60 min时
重度患儿		?	?	?	?
?	高剂量组	26	56.42±4.97	49.43±3.95^a	45.32±6.87^a
?	低剂量组	24	55.71±5.23	52.15±4.32^a	49.50±7.12^a
?	t	?	－0.448	2.311	2.087
?	P	?	0.628	0.025	0.042
轻度患儿		?	?	?	?
?	高剂量组	53	48.31±4.95	41.92±6.83^a	40.21±5.07^a
?	低剂量组	54	47.12±5.09	44.27±7.12^a	43.17±4.59^a
?	t	?	－1.160	－2.628	3.322
?	P	?	0.249	0.010	0.001

表2 两组患儿治疗前及接受雾化吸入治疗30 min，60 min时的呼吸频率比较(次/min，±s)

Table 2 Comparison of respiratory rate between two groups at admission, and treatment 30 min, 60 min (/min，±s)

组别		n	治疗前	30 min时	60 min时
重度患儿		?	?	?	?
?	高剂量组	26	56.42±4.97	49.43±3.95^a	45.32±6.87^a
?	低剂量组	24	55.71±5.23	52.15±4.32^a	49.50±7.12^a
?	t	?	－0.448	2.311	2.087
?	P	?	0.628	0.025	0.042
轻度患儿		?	?	?	?
?	高剂量组	53	48.31±4.95	41.92±6.83^a	40.21±5.07^a
?	低剂量组	54	47.12±5.09	44.27±7.12^a	43.17±4.59^a
?	t	?	－1.160	－2.628	3.322
?	P	?	0.249	0.010	0.001

表3 两组患儿治疗前及接受雾化吸入治疗30 min，60 min时的血氧饱和度比较(%，±s)

Table 3 Comparison of pulse oxygen saturation between two groups at admission, and treatment 30 min, 60 min (%，±s)

组别		n	治疗前	30 min时	60 min时
重度患儿		?	?	?	?
?	高剂量组	26	90.87±2.95	95.79±2.41^a	97.63±2.28^a
?	低剂量组	24	91.26±3.12	93.36±2.73^a	95.52±3.46^a
?	t	?	0.454	－3.349	－2.562
?	P	?	0.652	0.002	0.014
轻度患儿		?	?	?	?
?	高剂量组	53	93.81±3.23	97.41±2.15^a	98.42±1.49^a
?	低剂量组	54	93.52±3.18	95.41±3.52^a	96.53±2.73^a
?	t	?	－0.390	－3.596	－4.593
?	P	?	0.698	<0.001	<0.001

表3 两组患儿治疗前及接受雾化吸入治疗30 min，60 min时的血氧饱和度比较(%，±s)

Table 3 Comparison of pulse oxygen saturation between two groups at admission, and treatment 30 min, 60 min (%，±s)

组别		n	治疗前	30 min时	60 min时
重度患儿		?	?	?	?
?	高剂量组	26	90.87±2.95	95.79±2.41^a	97.63±2.28^a
?	低剂量组	24	91.26±3.12	93.36±2.73^a	95.52±3.46^a
?	t	?	0.454	－3.349	－2.562
?	P	?	0.652	0.002	0.014
轻度患儿		?	?	?	?
?	高剂量组	53	93.81±3.23	97.41±2.15^a	98.42±1.49^a
?	低剂量组	54	93.52±3.18	95.41±3.52^a	96.53±2.73^a
?	t	?	－0.390	－3.596	－4.593
?	P	?	0.698	<0.001	<0.001

表4 两组患儿平均住院时间、住院费用比较 (±s)

Table 4 Comparison of hospitalization time and expenses between two groups(±s)

组别		n	住院时间(d)	住院费用(元)
重度患儿		?	?	?
?	高剂量组	26	8.62±2.67	2573±196
?	低剂量组	24	10.73±3.27	2816±184
?	t	?	2.504	4.556
?	P	?	0.016	<0.001
轻度患儿		?	?	?
?	高剂量组	53	6.17±1.64	2029±213
?	低剂量组	54	7.12±1.28	2215±162
?	t	?	3.721	5.504
?	P	?	<0.001	<0.001

表4 两组患儿平均住院时间、住院费用比较 (±s)

Table 4 Comparison of hospitalization time and expenses between two groups(±s)

组别		n	住院时间(d)	住院费用(元)
重度患儿		?	?	?
?	高剂量组	26	8.62±2.67	2573±196
?	低剂量组	24	10.73±3.27	2816±184
?	t	?	2.504	4.556
?	P	?	0.016	<0.001
轻度患儿		?	?	?
?	高剂量组	53	6.17±1.64	2029±213
?	低剂量组	54	7.12±1.28	2215±162
?	t	?	3.721	5.504
?	P	?	<0.001	<0.001

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Comparison Study on the Efficacy of Bronchiolitis Between Different Dosage of Nebulised Budesonide Suspension for Inhalation

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Comparison Study on the Efficacy of Bronchiolitis Between Different Dosage of Nebulised Budesonide Suspension for Inhalation