摘要
小儿哮喘/婴幼儿喘息急性发作治疗时应该考虑下述方式:①最快捷的给药途径为吸入/雾化吸入疗法,可使药物直接吸至下气道和肺,以快速缓解支气管收缩及其伴随的急性临床症状,持续时间较长,疗效好,不良反应少。②最速效的救急药物为M3受体阻断剂/β2-受体激动剂。前者如异丙托溴胺能有效松弛支气管平滑肌以发挥解痉作用,后者如沙丁胺醇具有高选择性作用,作用维持时间长,给药途径多,为哮喘急性发作首选的对症治疗支气管弛张药。③最合理的组合雾化液如复方异丙托溴铵雾化液,是异丙托溴胺和沙丁胺醇混合制剂,异丙托溴胺能在整个肺部都起作用,沙丁胺醇为分布在周边小气道的β2-肾上腺素能受体的激动剂,这两种药物合用可协同增强疗效,除具有该两种药物各自的药理作用外,更起着相辅相成的互补作用。复方异丙托溴铵常采用雾化吸入的雾化液,使用简便。
Asthma exacerbation in young children accounts for significant number of emergency room visits each year. Symptoms of acute asthma attack must be promptly controlled according to the guidelines of Global Initiative for Asthma （GINA） treatments normally include utilization of the fast delivery routes, application of short acting asthma medications and optimal combination of drugs via nebulizer. The fast delivery routes are inhalation or nebulization therapy. Asthma medicine delivered by inhalation or nebulization can immediately reach the lower airway and lungs to relieve bronchospasm. These medicines have very low side effects since they are not absorbed in large quantities systemically. Recently, this therapy has been used widely in the treatment of acute wheezing episodes in children, such as acute asthma attack, bronchiolitis, and wheezing bronchitis. GINA （2006） recommended that inhalation therapy is the best treatment of choice for asthma. Commonly used short-acting asthma medications are M3-receptor antagonists and/or β2-receptor agonists. Ipratropine, an anticholinergic agent, antagonizes the effects of acetylcholine and relaxes bronchial smooth＇muscle. In contrast, salbutamol is a selective β2-adrenergic receptor agonist. It is highly selective and has longer acting time, and multiple administration routes. Salbutamol has now become the first-line bronchodilator for acute asthmas exacerbation. The most popular combined treatment was Combivent inhalation aerosol. This aerosol （Boehringer Ingelheim Pharm, Germany） combination ipratropine and salbutamol. Ipratropine, an anticholinergic agent, affects mostly the larger airways due to their rich distribution of parasympathetic nervous system. In contrast, salbutamol selectively agonizes the β2-adrenergic receptors which are more commonly distributed in the smaller airways. Therefore, ipratropine and salbutamol have excellent synergistic effects on bronchodilation.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2008年第3期258-261,共4页
Journal of Clinical Pediatrics
