中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2010年
5期
490-493
,共4页
慢性阻塞性肺疾病%雾化吸入%皮质类固醇激素
慢性阻塞性肺疾病%霧化吸入%皮質類固醇激素
만성조새성폐질병%무화흡입%피질류고순격소
Chronic obstructive pulmonary disease%Nebulised%Corticosteroid
目的 探讨慢性阻塞性肺疾病急性加重(AECOPD)患者雾化吸入激素能否替代全身应用激素.方法 将78例AECOPD患者随机分为3组:支气管舒张剂(SBDT)组29例,雾化吸入万托林2.5 mg/0.5 ml+爱全乐500 mg/2 ml,4次/d;全身应用激素(SC)组23例,在SBDT组治疗基础上给予甲泼尼龙40 mg静脉滴注1次/d;雾化吸入激素(NB)组26例,在SBDT组治疗基础上给予雾化吸入布地奈德1 mg,4次/d.观察3组患者血象、生化、血气、肺功能、10 d出院率、15 d后出院率及血糖、精神症状等情况.结果 SC及NB组血氧饱和度(SO2)、氧分压(PO2)及第1秒用力呼气量占预计值的百分比(FEV1 pred)等指标的改善率分别为(5.3±0.9)%与(5.9±0.4)%,(8.7±0.5)%与(8.1±0.8)%,(4.9±0.4)%与(7.2±0.5)%,均较SBDT组[(3.2±0.3)%、(5.7±0.7)%、(3.6±0.3)%]高(P均＜0.05),而上述各项指标SC组较NB组均无明显差异.3组患者10 d出院率、15 d后出院率差异无统计学意义,但出院后1个月急性加重率SBDT组较SC及NB组明显增高[12%(3/26)、5%(1/20)、9%(2/23),P均＜0.05],出院后1个月内再入院率SBDT组较SC及NB组明显增高[8%(2/26)、5%(1/20)、5%(1/23),P均＜0.05].SC组血糖在住院第10天[(7.4±1.6)mmol/L]有上升趋势,较SBDT组[(5.1±0.8)mmol/L]及NB组[(5.6±1.2)mmol/L]升高(P均＜0.05),且SC组有1例出现躁动、谵妄精神症状.结论 全身应用激素有效,但有副作用;雾化吸入激素与全身激素疗效相当,但副作用少;雾化吸入激素可能是一安全且有效的治疗方法 ,可替代全身激素治疗AECOPD.
目的 探討慢性阻塞性肺疾病急性加重(AECOPD)患者霧化吸入激素能否替代全身應用激素.方法 將78例AECOPD患者隨機分為3組:支氣管舒張劑(SBDT)組29例,霧化吸入萬託林2.5 mg/0.5 ml+愛全樂500 mg/2 ml,4次/d;全身應用激素(SC)組23例,在SBDT組治療基礎上給予甲潑尼龍40 mg靜脈滴註1次/d;霧化吸入激素(NB)組26例,在SBDT組治療基礎上給予霧化吸入佈地奈德1 mg,4次/d.觀察3組患者血象、生化、血氣、肺功能、10 d齣院率、15 d後齣院率及血糖、精神癥狀等情況.結果 SC及NB組血氧飽和度(SO2)、氧分壓(PO2)及第1秒用力呼氣量佔預計值的百分比(FEV1 pred)等指標的改善率分彆為(5.3±0.9)%與(5.9±0.4)%,(8.7±0.5)%與(8.1±0.8)%,(4.9±0.4)%與(7.2±0.5)%,均較SBDT組[(3.2±0.3)%、(5.7±0.7)%、(3.6±0.3)%]高(P均＜0.05),而上述各項指標SC組較NB組均無明顯差異.3組患者10 d齣院率、15 d後齣院率差異無統計學意義,但齣院後1箇月急性加重率SBDT組較SC及NB組明顯增高[12%(3/26)、5%(1/20)、9%(2/23),P均＜0.05],齣院後1箇月內再入院率SBDT組較SC及NB組明顯增高[8%(2/26)、5%(1/20)、5%(1/23),P均＜0.05].SC組血糖在住院第10天[(7.4±1.6)mmol/L]有上升趨勢,較SBDT組[(5.1±0.8)mmol/L]及NB組[(5.6±1.2)mmol/L]升高(P均＜0.05),且SC組有1例齣現躁動、譫妄精神癥狀.結論 全身應用激素有效,但有副作用;霧化吸入激素與全身激素療效相噹,但副作用少;霧化吸入激素可能是一安全且有效的治療方法 ,可替代全身激素治療AECOPD.
목적 탐토만성조새성폐질병급성가중(AECOPD)환자무화흡입격소능부체대전신응용격소.방법 장78례AECOPD환자수궤분위3조:지기관서장제(SBDT)조29례,무화흡입만탁림2.5 mg/0.5 ml+애전악500 mg/2 ml,4차/d;전신응용격소(SC)조23례,재SBDT조치료기출상급여갑발니룡40 mg정맥적주1차/d;무화흡입격소(NB)조26례,재SBDT조치료기출상급여무화흡입포지내덕1 mg,4차/d.관찰3조환자혈상、생화、혈기、폐공능、10 d출원솔、15 d후출원솔급혈당、정신증상등정황.결과 SC급NB조혈양포화도(SO2)、양분압(PO2)급제1초용력호기량점예계치적백분비(FEV1 pred)등지표적개선솔분별위(5.3±0.9)%여(5.9±0.4)%,(8.7±0.5)%여(8.1±0.8)%,(4.9±0.4)%여(7.2±0.5)%,균교SBDT조[(3.2±0.3)%、(5.7±0.7)%、(3.6±0.3)%]고(P균＜0.05),이상술각항지표SC조교NB조균무명현차이.3조환자10 d출원솔、15 d후출원솔차이무통계학의의,단출원후1개월급성가중솔SBDT조교SC급NB조명현증고[12%(3/26)、5%(1/20)、9%(2/23),P균＜0.05],출원후1개월내재입원솔SBDT조교SC급NB조명현증고[8%(2/26)、5%(1/20)、5%(1/23),P균＜0.05].SC조혈당재주원제10천[(7.4±1.6)mmol/L]유상승추세,교SBDT조[(5.1±0.8)mmol/L]급NB조[(5.6±1.2)mmol/L]승고(P균＜0.05),차SC조유1례출현조동、섬망정신증상.결론 전신응용격소유효,단유부작용;무화흡입격소여전신격소료효상당,단부작용소;무화흡입격소가능시일안전차유효적치료방법 ,가체대전신격소치료AECOPD.
Objective To test the hypothesis that nebulised budesonide (NB) might be an alternative to systemic corticosteroids in treatment of patients with exacerbated chronic obstructive pulmonary disease (ECOPD).Methods Patients hospitalised with ECOPD (n = 78) were randomnized into three groups.Group 1 received only standard bronchodilator treatment (SBDT),group 2 received systemic corticosteroids (SC 40 mg methylprednisolone) plus SBDT,and group 3 received nebulised budesonide ( NB 1000 mg budesonide q.i.d.) plus SBDT.Complete blood counts,detailed biochemical analysis,spirometric measurements and arterial blood gas analysis were carried out at admission.In addition,the following were recorded:adverse effects,discharging percentage of patients at 10 day and 15 day after hospitalization,exacerbation and re-hospitalization ratio within 1month after discharge.Results The improvement of SO2,PO2,FEV1 and discharge rates was ( 5.3± 0.9 ) %、(5.9 ±0.4)%、(8.7 ±0.5)% ,(8.1 ±0.8)%,(4.9 ±0.4)% and (7.2 ±0.5)% ,which were higher than that in SBDT group.These indexes were not different between 2 group and 3 group.The fraction of patients discharged on the 10th day and 15th were not different.The deteriorate rate was higher in 1 group than in 2 group and 3 group(P ＜0.05 ).Re-admission ratio in one month is higher in 1 group( 12% ) than in 2 group( 5% ) and 3 group(9% ) ( P ＜0.05 ).Absolute blood glucose level was found to be significantly higher in group 2 in 10th day (7.4 ± 1.6)mmol/L,which is greater than that in 1 group ( 5.1 ± 0.8 ) mmol/L and 3 group ( 5.6 ± 1.2 ) mmol/L ( P ＜ 0.05 ).Dysphoria and deliration appear in one patient in group 2.Conclusions Nebulised budesonide,an effective and safe alternative to systemic corticosteroids in treatment of exacerbated COPD,may substitute systemic corticosteroids in clinical practice.
