目的 比较储雾罐吸入丙酸氟替卡松气雾剂与雾化吸入布地奈德混悬液对毛细支气管炎预后的影响。方法 选取2016年9月-2018年6月在北京市通州区妇幼保健院入院并确诊毛细支气管炎患儿187例,根据随机数字表分为氟替卡松组(67例)、布地奈德组(63例)和对照组(57例)。分别在出院后给予储雾罐吸入丙酸氟替卡松气雾剂和雾化吸入布地奈德混悬液,对照组不予吸入任何糖皮质激素。随访观察1个月,比较三组患儿随访前后潮气肺功能、呼出气一氧化氮(FeNO),随访后喘息反复发作的情况。结果 完成随访患儿氟替卡松组67例、布地奈德组62例和对照组56例,干预后两组患儿潮气肺功能达峰时间比(TPTEF／TE)、达峰容积比(VPEF／VE)较干预前上升、FeNO较干预前下降,差异有统计学意义(P＜0.05)。两组在干预后1个月咳喘反复例数均明显低于对照组,组间比较差异无统计学意义(P＞0.05)。结论 吸入丙酸氟替卡松可在短期内有效防治毛细支气管炎感染后咳喘复发,减轻气道炎症反应,改善肺功能。储雾罐吸入方式可以替代雾化吸入改善毛细支气管炎预后,并具有便捷优势。

Objective To compare the effect of inhaled fluticasone propionate with a spacer and atomization inhalation budesonide suspension on the prognosis of children with acute bronchiolitis. Methods A total of 187 infants diagnosed with bronchiolitis in Tongzhou Maternal and Child Health Hospital of Beijing from September 2016 to June 2018 were enrolled in this study and were randomly divided into fluticasone treatment group(67 cases),budesonide treatment group(63 cases) and control group(57 cases).Fluticasone treatment group received inhaled fluticasone propionate with a spacer,budesonide treatment group was given atomization inhalation budesonide suspension,and the infants in control group did not receive any inhalation of corticosteroids after hospital discharge.All children were followed up for 1 month,and lung function and the fractional exhaled nitric oxide(FeNO),the recurrent wheezing times were compared before and after the follow-up. Results The number of children who completed follow-up in fluticasone treatment group,budesonide treatment group and control group was 67,62 and 56 cases,respectively.After the intervention,the ratio of time to peak tidal expiratory flow to total expiratory time(TPTEF/TE) and ratio of volume to peak expiratory flow to total expiratory volume(VPEF/VE) were significantly higher than those before intervention(P<0.05),but the FeNO was significantly lower than that before intervention(P<0.05).The number of children with recurrent wheezing in the two groups was significantly lower than that in the control group,but the difference was not significant(P>0.05). Conclusions Inhaled fluticasone propionate can effectively prevent and treat the relapse of cough and wheezing after bronchiolitis in the short term,reduce the airway inflammation and improve the lung function.The way of inhale corticosteroid with a spacer is so handy that it can replace aerosol inhalation to improve the prognosis of bronchiolitis.