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目的观察升级治疗与标准治疗对支气管哮喘的临床疗效,以求找出治疗哮喘最佳方法。方法对2009年1—12月在绍兴市人民医院哮喘专科门诊就诊的98例支气管哮喘病情未控制的患儿,随机分成标准治疗组与升级治疗组。标准治疗组按GINA和《儿童支气管哮喘诊断与防治指南》的分级标准进行治疗,升级治疗组则在此基础上升一个级别治疗4~8周,症状缓解、肺功能正常后给予降级治疗。治疗随访1年,每4周检测1次肺功能、症状评分(C-ACT),观察2组患儿的C-ACT、肺功能及不良反应。结果治疗后4周、8周升级治疗组C-ACT、肺功能明显好于标准治疗组;1年后2组患儿各项指标差异无统计学意义,不良反应2组差异无统计学意义。结论升级治疗是支气管哮喘治疗过程中可选取的方法之一,但需及时降级,以减少不良反应。
Objective To observe the clinical effects of escalation therapy and standard therapy on bronchial asthma in order to find out the best way to treat asthma. Methods From January to December 2009, 98 children with uncontrolled bronchial asthma who were treated in the asthma specialist outpatient department of Shaoxing People’s Hospital were randomly divided into standard treatment group and escalation treatment group. The standard treatment group according to GINA and “children bronchial asthma diagnosis and prevention guidelines,” the grading standards for treatment, upgrade treatment group is based on the basis of a level of treatment for 4 to 8 weeks, the symptoms relieved, pulmonary function was normal after the downgrade treatment. The patients were followed up for 1 year. The pulmonary function and symptom scores (C-ACT) were measured every 4 weeks. The C-ACT, pulmonary function and adverse reactions in the two groups were observed. Results After 4 and 8 weeks of treatment, C-ACT and pulmonary function in the treatment group were significantly better than those in the standard treatment group. There was no significant difference in each index between the two groups after 1 year and no significant difference between the two groups. Conclusion Escalation therapy is one of the methods that can be taken in the course of bronchial asthma treatment, but it needs to be demoted in time to reduce the adverse reactions.