目的 探討氨溴索聯(lián)合甲潑尼龍治療兒童哮喘急性發(fā)作的臨床效果。方法 選取2015年1月—2017年1月河南科技大學(xué)第一附屬醫(yī)院開(kāi)元院區(qū)收治的哮喘急性發(fā)作患兒78例，隨機(jī)分成對(duì)照組（39例）和治療組（39例）。對(duì)照組靜脈滴注注射用甲潑尼龍琥珀酸鈉，1 mg/kg加入5%葡萄糖注射液100 mL，1次/d。治療組在對(duì)照組治療基礎(chǔ)上靜脈滴注鹽酸氨溴索注射液，15 mg加入5%葡萄糖注射液100 mL，2次/d。兩組均連續(xù)治療7 d。觀察兩組患者臨床療效，同時(shí)比較治療前后兩組患者癥狀體征緩解時(shí)間、第1秒用力呼氣容積占預(yù)計(jì)值百分比（FEV1%）、FEV1/用力肺活量（FVC）值、呼出氣一氧化氮（FeNO）水平、兒童哮喘控制測(cè)試（C-ACT）評(píng)分、γ干擾素（IFN-γ）、白細(xì)胞介素-4（IL-4）和輔助性T細(xì)胞17（Th17）/調(diào)節(jié)性T細(xì)胞（Treg）比值。結(jié)果 治療后，對(duì)照組的總有效率為79.5%，顯著低于治療組的94.9%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組患兒喘息、咳嗽、氣促、哮鳴音、濕羅音癥狀體征緩解時(shí)間比對(duì)照組顯著縮短（P<0.05）。治療后，兩組FEV1%、FEV1/FVC值和C-ACT評(píng)分均明顯增加（P<0.05），F(xiàn)eNO水平顯著下降（P<0.05），且治療后治療組這些理化指標(biāo)及C-ACT評(píng)分比對(duì)照組改善更明顯（P<0.05）。治療后，兩組血清IFN-γ濃度顯著升高（P<0.05），血清IL-4水平及外周血Th17/Treg比率顯著降低（P<0.05），且治療組IFN-γ、IL-4和Th17/Treg比對(duì)照組改善更明顯（P<0.05）。結(jié)論 氨溴索聯(lián)合甲潑尼龍治療兒童哮喘急性發(fā)作療效顯著，可迅速減輕患兒癥狀，提高肺通氣功能，改善氣道炎癥，緩解哮喘病情。

Objective to explore the clinical effect of ambroxol combined with methylprednisolone in treatment of acute asthma attack in children. Methods Children (78 cases) with acute asthma attack in Kaiyuan District of the First Affiliated Hospital of Henan University of Science & Technology from January 2015 to January 2017 were randomly divided into control (39 cases) and treatment (39 cases) groups. Children in the control group were iv administered with Methylprednisolone Sodium Succinate for injection, 1 mg/kg added into 5% glucose injection 100 mL, once daily. Children in the treatment group were iv administered with Ambroxol Hydrochloride Injection on the basis of the control group, 15 mg added into 5% glucose injection 100 mL, twice daily. Children in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the relief time of symptoms and signs, FEV1%, FEV1/FVC, FeNO levels, C-ACT scores, IFN-γ, IL-4, and Th17/Treg ratios in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 79.5%, which was significantly lower than 94.9% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the relief time of wheezing, cough, shortness of breath, wheezing rale, and wet rales in the treatment group was significantly shorter than that in the control group (P<0.05). After treatment, the FEV1%, FEV1/FVC, and C-ACT scores in two groups were significantly increased (P<0.05), but the FeNO levels were significantly decreased (P<0.05), and these physical and chemical indexes and C-ACT scores in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the serum IFN-γ concentration in two groups was significantly increased (P<0.05), but serum IL-4 and Th17/Treg ratio of peripheral blood were significantly decreased (P<0.05), and the IFN-γ, IL-4, Th17/Treg levels in treatment group were significantly better than those in the control group (P<0.05). Conclusion Ambroxol combined with methylprednisolone has significant curative effect in treatment of acute asthma attack in children, can quickly relieve the symptoms, improve the pulmonary ventilation function, improve the airway inflammation, and alleviate asthma.