孟鲁司特联合丙酸氟替卡松鼻喷剂治疗儿童鼾症的临床研究

Efficacy of montelukast combined with fluticasone propionate nasal spray in the treatment of snoring in children

摘要:

目的 探讨孟鲁司特联合丙酸氟替卡松鼻喷剂治疗儿童鼾症的临床疗效。方法 选取2015年7月—2018年5月湖南省直中医医院收治的82例鼾症患儿作为研究对象。按照随机数字表法将患儿分为观察组和对照组。对照组采用丙酸氟替卡松鼻喷剂治疗。观察组在对照组基础上，采用孟鲁司特治疗。比较两组患者治疗后的总有效率。检测全部患者治疗前后血清白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）的水平。运用多导睡眠监测系统监测患儿睡眠效率、最低血氧饱和度（LSaO₂）、每小时睡眠内呼吸暂停加上低通气的次数（AHI）、微觉醒指数的水平。运用生活质量调查表评估患者的生活质量。结果 观察组临床总有效率较对照组高（P <0.05）。观察组治疗前后IL-6和TNF-α的差值较对照组高（P <0.05）。观察组治疗前后睡眠效率、LSaO₂、AHI、微觉醒指数的差值较对照组高（P <0.05）。观察组治疗前后睡眠障碍、情绪状况、白天功能、身体状况、对监护人影响的差值较对照组高（P <0.05）。结论 孟鲁司特可提高儿童鼾症的疗效，改善患者的睡眠质量和生活质量，降低炎症因子水平。

Abstract:

Objective To investigate the clinical effect of montelukast combined with fluticasone propionate nasal spray on snoring in children.Methods A total of 82 children with snoring were enrolled and divided into observation group and control group. The control group was treated with fluticasone propionate nasal spray, while the observation group was treated with montelukast on the basis of the control group. The overall effective rate was compared between the two groups. The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured before and after treatment. Polysomnography (PSG) was used to monitor the sleep efficiency, lowest blood oxygen saturation (LSaO₂), apnea-hypopnea index (AHI) and micro-arousal index. Obstructive Sleep Apnea-18 (OSA-18) scale was applied to assess the patients' quality of life.Results The overall effective rate of the observation group was higher than that of the control group after treatment (P < 0.05). The differences of IL-6 and TNF-α levels before and after the treatment in the observation group were greater than those in the control group (P < 0.05). The differences of the sleep efficiency, LSaO₂, AHI and micro-arousal index before and after the treatment were also greater in the observation group (P < 0.05). As for the patients' quality of life, the observation group showed greater changes in the aspects of the sleep disturbance, emotional distress, daytime problems, physical suffering and caregiver concerns after treatment (P < 0.05).Conclusions Montelukast exhibits synergistic therapeutic effects with fluticasone propionate nasal spray in the treatment of snoring in children. It can not only improve the quality of sleep and life, but reduce the level of inflammatory factors in the patients.