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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 anticholinergic drug tiotropium in children with poorly controlled asthma. Methods: From January 2013 to January 2014, our hospital outpatient diagnosis of asthma in children with moderate persistent asthma, according to the 2008 revision of "children’s bronchial asthma diagnosis and prevention guidelines for clinical evaluation, to fluticasone propionate aerosol Shu ketone, 125μg / time, 2 times / d) for 3 months were still assessed as uncontrolled asthma in 60 patients. A group was randomly divided into four groups: Fu-Quxu 125μg / time, morning and evening 2 spray; B group: Fu-Shu ketone 125μg / time, 2 times / d + formoterol powder inhalation ; Group C: Fu-Shu ketone 125μg / time, 2 times / d + tiotropium bromide inhalation agent (Sihua, 18μg 1 / d), observed for 4 weeks. Results: There was no significant difference in pulmonary function before and after treatment in group A, but the difference was not statistically significant. The percentage of predicted value of FEV1 and PEF in group B and group C after treatment was significantly higher than that before treatment (P <0.001). The scores of nighttime clinical symptom scores in children with poorly controlled asthma were significantly higher than those in the daytime clinical symptom scores (P <0.001). The scores of clinical symptom score in daytime and nighttime were significantly improved in all three groups (P <0.001) ; Group C night clinical symptom score improved more significantly than the B group (P <0.05). CONCLUSIONS: For patients with moderate persistent low-dose glucocorticoid-induced asthma control, daily use of long-acting blocker-tiotropium combined with long-acting β2-agonist did not respond well Rare reactions can be an alternative to asthma in children with poor outcomes.