联合噻托溴铵在哮喘控制不良患儿中的应用观察  

Efficacy of Inhaled Tiotropium in Children with Asthma,Uncontrolled with Standard Combination Therapy

作　　者：黄娟[1] 张军[1] 舒俊华[1] 陈颖[1] 陈霞[1] 龙珍[1] 周小勤[1] 戚红[1] 

机构地区：[1]湖北省妇幼保健院儿科,湖北武汉430072

出　　处：《武汉大学学报（医学版）》2015年第6期948-951,共4页Medical Journal of Wuhan University

基　　金：湖北省自然科学基金资助项目(编号:2013CFB048)

摘　　要：目的:观察抗胆碱能药物-噻托溴铵在哮喘控制不良患儿中的疗效。方法:2013年1月至2014年1月我院哮喘门诊诊断中度持续性哮喘患儿,按2008年修订《儿童支气管哮喘诊断与防治指南》进行临床评估,予丙酸氟替卡松气雾剂(辅舒酮,125μg/次,2次/d)治疗3个月仍评估为哮喘未控制者60例。随机分为A组:辅舒酮125μg/次,早晚各2喷;B组:辅舒酮125μg/次,2次/d+福莫特罗粉吸入剂(奥克斯都保)4.5μg 1次/d;C组:辅舒酮125μg/次,2次/d+噻托溴铵粉吸入剂(思力华,18μg 1次/d),观察4周。结果:A组患儿治疗前后肺功能无显著改善,差异无统计学意义;B组及C组治疗后FEV1和PEF占预计值百分比均较治疗前有显著改善(P<0.001)。哮喘控制不良患儿夜间临床症状评分显著高于日间临床症状评分(P<0.001);无论是日间还是夜间临床症状评分3组患儿治疗后均较治疗前有显著改善(P<0.001);C组夜间临床症状评分较B组改善更显著(P<0.05)。结论:对于低剂量糖皮质激素吸入哮喘控制不良的中度持续性患儿,每日加用一次长效受体阻滞剂-噻托溴铵与联合长效β2受体激动剂疗效相当,不良反应罕见,可成为哮喘治疗效果不佳患儿的另一种可选择方案。Objective：To observe the efficacy of inhaled tiotropium in children with asthma,uncontrolled with standard combination therapy.Methods：60uncontrolled patients which inhaled fluticasone（125μg,bid）for 3months from January 2013 to January 2014 in our hospital.They were randomly divided into Group A：Flixotide 250μg,bid;Group B：flixotide（125μg,bid）＋ formoterol（4.5μg,qd）;Group C：Flixotide（125μg,bid）＋tiotropium（18μg,qd）and were followed up for four weeks.Results：There was no significant improvement in the lung function of Group A before and after treatment.But the FEV1%and PEF% of group B and group C had significantly improved,P〈0.001.Uncontrolled asthma in children with the nocturnal symptoms score was significantly higher than daytime clinical symptom score in uncontrolled asthma,P〈0.001;after treatment there had a significant improvements in either the daytime or nighttimeclinical symptom scores than pre-treatment of the three groups,P〈0.001;the nighttime clinical symptom scores of group C had significantly improved than that in group B,P 0.05.Conclusion：Low-dose inhaled corticosteroids plus tiotropium has an equal effect with plus longactingβ2-agonist to the uncontrolled asthma in children and has no considerable adverse reaction,which may become a new treatment in poorly controlled asthma in children.

关 键 词：噻托溴铵 哮喘 未控制 患儿 

分 类 号：R725.6[医药卫生—儿科]