高渗盐水与等渗盐水联合沙丁胺醇雾化吸入佐治小儿毛细支气管炎临床疗效的对比研究

摘要

目的：比较高渗盐水与等渗盐水联合沙丁胺醇雾化吸入佐治小儿毛细支气管炎的临床疗效。方法选取2013年1月—2014年10月佛山市南海区妇幼保健院儿内科收治的180例毛细支气管炎患儿，按电脑产生的随机数字分为 A 组62例、B 组58例、C 组60例。3组患儿均给予抗感染、解痉、祛痰、氧疗等对症治疗；A 组患儿给予3%氯化钠溶液4 ml ＋硫酸沙丁胺醇2.5 mg 雾化吸入，B 组患儿给予0.9%氯化钠溶液4 ml ＋硫酸沙丁胺醇2.5 mg 雾化吸入，C 组患儿仅给予3%氯化钠溶液5 ml 雾化吸入；3组患儿雾化吸入频率均为3次/ d，连续治疗5 d。比较 3组患儿治疗前后动脉血气分析指标〔动脉氧分压（PaO2）、二氧化碳分压（PaCO2）、血氧饱和度（SpO2）〕、血清炎性递质〔白介素4（IL -4）、白介素8（IL -8）、嗜酸粒细胞阳离子蛋白（ECP）〕水平，临床疗效及不良反应。结果治疗前，3组患儿 PaO2、PaCO2、SpO2及血清 IL -4、IL -8、ECP 水平比较，差异无统计学意义（ P ＞0.05）；治疗后，A组患儿 PaO2高于 B 组和 C 组，PaCO2、血清 IL -4、ECP 水平低于 B 组和 C 组（P ＜0.05）。3组患儿临床疗效比较，差异无统计学意义（u ＝1.975，P ＞0.05）。治疗过程中，A 组、B 组分别有9例、11例患儿出现一过性心率加快，心率为117～141次/ min；C 组无一例患儿出现心率加快。结论高渗盐水（3%氯化钠溶液）联合沙丁胺醇佐治小儿毛细支气管炎的临床疗效与等渗盐水相近，但其动脉血气改善情况优于等渗盐水，且不增加不良反应发生风险。%Objective To compare the clinical effect in auxiliary treatment of children bronchiolitis between hypertonic saline and isotonic saline combined with salbutamol atomization inhalation. Methods From January 2013 to October 2014,a total of 180 children with bronchiolitis were selected in the Department of Pediatrics,Maternity and Child Care Centers of Nanhai District,Foshan,and they were divided into groups A(n = 62),B(n = 58),C(n = 60)according to computer generated random number. Children of the three groups received symptomatic treatment, including anti - infection, spasmolysis, eliminating phlegm,oxygen inhalation and so on;children of A group were given 3% sodium chloride solution( 4 ml) combined with salbutamol sulfate(2. 5 mg) atomization inhalation;children of B group were given 0. 9% sodium chloride solution(4 ml)combined with salbutamol sulfate(2. 5 mg)atomization inhalation;children of C group were given 3% sodium chloride solution(5 ml)only. All of the three groups continuously treated for 5 days,the atomization inhalation frequency were all 3 times per day. Arterial blood - gas index( including PaO2 ,PaCO2 and SpO2 ) and serum inflammatory transmitter level (including IL - 4,IL - 8 and ECP)before and after treatment,clinical effect and incidence of adverse reactions were compared among the three groups. Results No statistically significant differences of PaO2 ,PaCO2 ,SpO2 ,serum IL - 4,IL - 8,or ECP level was found among the three groups before treatment( P > 0. 05);after treatment,PaO2 of A group was statistically significantly higher than that of B group,C group,respectively,while PaCO2 ,serum IL - 4 and ECP levels of A groups were statistically significantly lower than those of groups B and C(P < 0. 05). No statistically significant differences of clinical effect was found among the three groups( u = 1. 975,P > 0. 05). During the treatment,9 cases of A group,11 cases of B group occurred transient increased heart rate(117 to 141 times/ min);no one of C group occurred increased heart rate. Conclusion Hypertonic saline combined with salbutamol atomization inhalation has similar clinical effect with isotonic saline in auxiliary treatment of children bronchiolitis,but hypertonic saline can effectively improve the arterial blood - gas index,without increasing the incidence of adverse reactions.