Huet F, Nivelon J L
Service de Pédiatrie I, Hôpital d'enfants, CHRU du Bocage, Dijon.
Rev Pneumol Clin. 1997;53(2):91-7.
Aerosol therapy in cystic fibrosis is indicated in order to administer active agents directly into the diseased organ. The practical application of this technique often remains a question of personal experience rather than rigorous and validated schemes. In order to determine the experience of those using this technique, a questionnaire was prepared by the health care centers certified by the French association against cystic fibrosis (65 centers). There were 53 responses (82%) covering 3400 patients. Two-thirds of these patients (2250) used nebulizers. Drugs used by order of frequency were: rhDNase (52 centers), antibiotics (51), conventional fluidifying agents (17), isotonic saline solution (14). Bronchodilators were used as sprays or inhalation chambers. Antibiotics most frequently prescribed were: colimycin (51 centers, doses 500.000 to 3 MIU per aerosol), tobramycin (44 centers, 25 to 600 mg per aerosol), amikacine (7 centers, 150 mg to 1.5 g per aerosol). Indications were mainly chronic colonization with Pseudomonas aeruginosa (39/53 centers) and episodes of bronchial superinfection with Pseudomonas aeruginosa (18/53 centers). Equipment maintenance appeared as the main problem in most centers (daily or more cleaning with antiseptic solutions in 46/53 centers). The differences in indications and dosages prescribed justify further prospective randomized studies to optimize treatment.
囊性纤维化的雾化治疗旨在将活性剂直接输送到患病器官。这项技术的实际应用往往更多地取决于个人经验,而非严格且经过验证的方案。为了了解使用该技术的人员的经验,法国抗囊性纤维化协会认证的医疗保健中心(65个中心)编制了一份问卷。共收到53份回复(82%),涉及3400名患者。其中三分之二的患者(2250名)使用雾化器。按使用频率排列的药物依次为:重组人脱氧核糖核酸酶(rhDNase,52个中心)、抗生素(51个中心)、传统的黏液溶解剂(17个中心)、等渗盐溶液(14个中心)。支气管扩张剂以喷雾剂或吸入装置的形式使用。最常开具的抗生素为:黏菌素(51个中心,每次雾化剂量为500,000至3百万国际单位)、妥布霉素(44个中心,每次雾化25至600毫克)、阿米卡星(7个中心,每次雾化150毫克至1.5克)。主要适应证为铜绿假单胞菌慢性定植(39/53个中心)和铜绿假单胞菌支气管重叠感染发作(18/53个中心)。在大多数中心,设备维护似乎是主要问题(46/53个中心每天或更频繁地用抗菌溶液进行清洁)。适应证和规定剂量的差异表明有必要进一步开展前瞻性随机研究以优化治疗。