目的 探讨氨溴索联合甲泼尼龙治疗儿童哮喘急性发作的临床效果。方法 选取2015年1月—2017年1月河南科技大学第一附属医院开元院区收治的哮喘急性发作患儿78例，随机分成对照组（39例）和治疗组（39例）。对照组静脉滴注注射用甲泼尼龙琥珀酸钠，1 mg/kg加入5%葡萄糖注射液100 mL，1次/d。治疗组在对照组治疗基础上静脉滴注盐酸氨溴索注射液，15 mg加入5%葡萄糖注射液100 mL，2次/d。两组均连续治疗7 d。观察两组患者临床疗效，同时比较治疗前后两组患者症状体征缓解时间、第1秒用力呼气容积占预计值百分比（FEV1%）、FEV1/用力肺活量（FVC）值、呼出气一氧化氮（FeNO）水平、儿童哮喘控制测试（C-ACT）评分、γ干扰素（IFN-γ）、白细胞介素-4（IL-4）和辅助性T细胞17（Th17）/调节性T细胞（Treg）比值。结果 治疗后，对照组的总有效率为79.5%，显著低于治疗组的94.9%，两组比较差异具有统计学意义（P<0.05）。治疗后，治疗组患儿喘息、咳嗽、气促、哮鸣音、湿罗音症状体征缓解时间比对照组显著缩短（P<0.05）。治疗后，两组FEV1%、FEV1/FVC值和C-ACT评分均明显增加（P<0.05），FeNO水平显著下降（P<0.05），且治疗后治疗组这些理化指标及C-ACT评分比对照组改善更明显（P<0.05）。治疗后，两组血清IFN-γ浓度显著升高（P<0.05），血清IL-4水平及外周血Th17/Treg比率显著降低（P<0.05），且治疗组IFN-γ、IL-4和Th17/Treg比对照组改善更明显（P<0.05）。结论 氨溴索联合甲泼尼龙治疗儿童哮喘急性发作疗效显著，可迅速减轻患儿症状，提高肺通气功能，改善气道炎症，缓解哮喘病情。

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.