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[摘要] 目的：探讨人血丙种球蛋白联合甲基泼尼松龙治疗重症毛细支气管炎的临床疗效。方法：将114例重症毛细支气管炎患儿随机分为治疗组及对照组，每组57例，两组患儿均给予吸氧、止咳平喘、抗感染等基础治疗，对照组患儿给予甲基泼尼松龙治疗，治疗组患儿给予甲基泼尼松龙联合丙种球蛋白治疗，治疗1周后观察两组患儿临床疗效。结果：治疗1周后，治疗组临床有效率为91.2%，对照组临床有效率为80.7%，治疗组临床有效率高于对照组，治疗组咳嗽、喘憋、哮鸣音消失及胸部X线好转时间短于对照组，差异具有统计学意义。结论：丙种球蛋白联合甲基泼尼松龙治疗重症毛细支气管炎比单用甲基泼尼松龙治疗更能够有效缓解临床症状，改善临床治疗效果。
[关键词] 丙种球蛋白；甲基泼尼松龙；毛细支气管炎重症；临床分析
[中图分类号] R974[文献标识码]B [文章编号]1674-4721（2011）06（a）-078-02
Clinical analysis of gamma globulin combinated methylprednisolone on severe bronchiolitis
TANG Dan1, SU Peiyuan2, LIANG Ping1
1.Department of Pediatrics, the Second Clinical College of Chengdu University of Traditional Chinese Medicine, Sichuan Province, Chengdu 611137, China; 2.Department of Respiration, Children"s Hospital of Chengdu, Sichuan Province, Chengdu 610017, China
[Abstract] Objective: To invesitate the clinial effect of gamma globulin combinated methylprednisolone on severe bronchiolitis. Methods: 114 cases of suffering children with severe bronchiolitis were selected and were randomly divided into therapia group and control group, there were 57 cases of suffering children in every group, all suffering children received treated with inhaling oxygen, antitussive and antiasthmatic, anti-infection, suffering children in control group treated with methylprednisolone, suffering children in therapia group treated with globulin combinated methylprednisolone, after one week, clinical curative effect were contrasted between control group and therapia group. Results: One week after treatment, clinical effective power was 91.2% in therapia group and was 80.7% in control group, clinical effective power was higher in therapia group than in control group, time of cough, gasping and rales disappearing was shorter in therapia group than in control group, time of lung X-ray plate improving was shorter in therapia group than in control group. Conclusion: Gamma globulin combinated methylprednisolone can release clinical symptom on severe bronchiolitis, improve clinical curative effect.
[Key words] Gamma globulin; Methylprednisolone; Bronchiolitis; Clinical analysis
毛细支气管炎是婴幼儿常见的呼吸道感染，好发于2岁以下尤其是6个月以内的小儿，喘憋和肺部哮鸣音是该病的突出表现，重症患者常并发肺部通气及换气功能障碍，甚至导致呼吸衰竭[1]，是婴幼儿常见的呼吸道致死性疾病之一。毛细支气管炎的病变与特应性体质或过敏体质患儿肺部的过度免疫反应及炎性渗出有关，本文就丙种球蛋白联合甲基泼尼松龙对重症毛细支气管炎的治疗作用进行探讨。
1 资料与方法
1.1 一般资料
选择成都市儿童医院2007年6月～2009年12月收治的重症毛细支气管炎患儿114例，其中，男72例，女42例，年龄2～17个月，平均（4.4±3.2）个月，患儿均具有不同程度的咳嗽、咳痰、喘憋症状，部分患儿伴有发绀、脱水或心力衰竭，部分患儿呼吸功能失代偿，X线片提示均有肺不张、肺气肿、小点片状阴影。所有患儿诊断均符合中华医学会儿科学会组关于毛细支气管炎诊断及分级标准，患儿临床资料入选后随机均分为治疗组及对照组，两组患儿年龄、性别、呼吸功能情况经统计学分析无显著差异，具有可比性。本研究内容为常规治疗方法，不涉及伦理学要求，患儿监护人对治疗内容均知情同意。
1.2 治疗方法
患儿入选后均常规行血常规、生化及血气分析实验室检查，行胸部X线摄片检查，给予心率计血氧检测，依据患儿病情给予低流量吸氧、镇静、平喘等治疗。乏氧症状明显者给予经鼻导管喷射吸氧或面罩给氧，采用β内酰胺类或头孢类抗生素抗感染。对照组患儿给予甲基泼尼松龙1～2 mg/（kg・次），每日3次静脉滴注，治疗组患儿给予甲基泼尼松龙1～2 mg/（kg・次），每日3次静脉滴注，人血丙种球蛋白（华兰生物工程有限公司，国药准字S10970031）400 mg/kg.，每日1次静脉滴注，应用2～3 d，总剂量不超过2 g/kg。
1.3 观察指标
治疗1周后，观察两组患儿临床治疗效果，治疗过程中观察两组患儿咳嗽、喘憋症状消失时间、肺部哮鸣音消失时间及肺部X线改变好转时间。
1.4 评价标准
1.4.1 疗效评价标准疗效评价标准按相关文献修改制定[2]，治愈：患儿临床症状消失，患者发绀及肺部�音等体征消失，胸部X线变化消失。好转：患儿临床症状缓解，发绀及肺部�音等体征减轻，胸部X线变化减轻。无效：临床症状无改善或加重，发绀及肺部�音等体征无变化或加重，胸部X线表现无改善或加重。
1.4.2 肺部X线变化评价标准肺部X线变化评价按相关文献修改制定[3]：肺部X线肺部渗出或肺不张影像消失或肺部病变密度降低，范围减小大于1/4，无新增病变出现评定为好转。
1.5 统计学分析
数据处理采用SPSS 17.0统计学软件，统计学方法计量资料采用t检验，计数资料用χ２检验，检验水准α=0.05，P
