宁宁+丁国标+黎海燕

[摘要] 目的 探讨酮替芬联合孟鲁司特钠治疗儿童咳嗽变异性哮喘（CVA）的临床效果和安全性。 方法 选取我院2013年5月～2015年3月门诊收治的96例CVA患儿，运用随机数表法分为4组：对照组、酮替芬组、孟鲁司特组、合用组，4组均接受布地奈德鼻喷剂和口服丙卡特罗片；对照组不加用任何药物；酮替芬组在对照组基础上加用酮替芬片；孟鲁司特组在对照组基础上加用孟鲁司特钠片；合用组在对照组基础上使用酮替芬联合孟鲁司特钠治疗。比较4组的治疗前后肺功能，咳嗽缓解、消失时间和临床效果，不良反应等。 结果 合用组的咳嗽缓解时间[（5.3±2.2）h]和咳嗽消失时间[（9.4±2.4）h]明显短于对照组[（8.1±4.9）、（13.4±4.1）h]（P<0.05），但酮替芬组的咳嗽缓解时间[（7.8±3.4）h]和消失时间[（11.5±3.8）h]及孟鲁司特组的时间[（6.7±2.9）、（10.5±4.8）h]与对照组比较差异无统计学意义（P>0.05）。酮替芬组、孟鲁司特组、合用组的上述指标差异无统计学意义（P>0.05）。酮替芬组、孟鲁司特组、合用组的总有效率（83.3%、87.5%、91.7%）显著高于对照组（66.7%），但其余3组比较差异无统计学意义（P>0.05）。合用组的肺功能优于对照组（P<0.05），但酮替芬组、孟鲁司特组、合用组比较差异无统计学意义（P>0.05）。酮替芬组、孟鲁司特组、合用组的总不良反应发生率（5.6%）明显低于对照组（12.5%）（P<0.05）。 结论 酮替芬联合孟鲁司特治疗儿童咳嗽变异性哮喘的临床效果显著，治疗总有效率高，咳嗽症状明显改善，且安全性高，无严重不良反应，值得临床推广。

[关键词] 酮替芬；孟鲁司特钠；咳嗽变异性哮喘；儿童

[中图分类号] R562.2+5 [文献标识码] A [文章编号] 1674-4721（2015）09（c）-0099-04

Observation of clinical effect and safety of ketotifen combined with montelukast sodium in the treatment of cough variant asthma in children

NING Ning DING Guo-biao LI Hai-yan

Department of Pediatric Internal Medicine，Jiujiang Maternal and Child Health Hospital in Jiangxi Province，Jiujiang 332000，China

[Abstract] Objective To explore the clinical effect and safety of ketotifen combined with montelukast sodium in the treatment of cough variant asthma （CVA） in children. Methods 96 children with CVA admitted into outpatient of our hospital from May 2013 to March 2015 were selected.They were randomly divided into four groups based on a random number table method： control group，ketotifen group，montelukast group and combined group.The four groups were all given budesonide nasal spray and oral procaterol tablet，and control group was not further given any medication，and ketotifen group was further given ketotifen tablet on the basis of control group，and montelukast group was further given montelukast sodium tablet on the basis of control group，and combined group was further given ketotifen combined with montelukast sodium on the basis of control group.Pulmonary function before and after treatment，cough remission and disapperaing time，clinical effect and adverse reaction among four groups was compared respectively. Results Cough remission time [（5.3±2.2） h] and cough disappearing time [（9.4±2.4） h] in combined group was significantly shorter than that of control group [（8.1±4.9），（13.4±4.1） h] （P<0.05），but compared with control group，there was no statistical difference in the cough remission time [（7.8±3.4） h] and disappearing time [（11.5±3.8） h] in the ketotifen group and the time [（6.7±2.9），（10.5±4.8） h] in montelukast group （P>0.05）.There was no statistical difference of above-mentioned among ketotifen group，montelukast group and combined group （P>0.05）.The total effective rate in ketotifen group，montelukast group，and combined group （83.3%，87.5% and 91.7% respectively） was significantly higher than that of control group （66.7%），but there was no statistical difference among ketotifen group，montelukast group and combined group （P>0.05）.The pulmonary function in combined group was better than that in control group （P<0.05），but there was no statistical difference among ketotifen group，montelukast group and combined group （P>0.05）.The total incidence rate of adverse

reaction in ketotifen group，montelukast group and combined group （5.6%） was lower than that of control group （12.5%） （P<0.05）. Conclusion Ketotifen combined with montelukast sodium in the treatment of cough variant asthma in children has a significant clinical effect with high total effective rate of treatment，obvious improvement of cough symptom，high safety and no severe adverse reaction，which is worthy of clinical promotion.

[Key words] Ketotifen；Montelukast sodium；Cough variant asthma；Children

咳嗽变异性哮喘（cough variant asthma，CVA）（哮喘）是临床表现主要为慢性咳嗽的一种特殊哮喘类型疾病。我国大约有1%的儿童患有哮喘病，CVA占哮喘病的30%左右[1]。CVA极易被误诊为急性支气管炎或是上呼吸道感染，耽误儿童的病情治疗[2]。临床上治疗CVA的方案并未统一，以往治疗的常用药物是酮替芬片[3]，但是在治疗后病情容易复发。孟鲁司特钠是白三烯受体拮抗剂，近年来也被广泛用于治疗CVA，然而对两者联用的临床效果的报道却少之又少，为探究酮替芬联合孟鲁司特钠治疗儿童CVA的临床效果和安全性，笔者选取96例患儿进行分组治疗，现报道如下。