广州医学院学报
廣州醫學院學報
엄주의학원학보
ACADEMIC JOURNAL OF GUANGZHOU MEDICAL COLLEGE
2014年
2期
39-42
,共4页
慢性阻塞性肺疾病%急性加重期%高龄%布地奈德%甲强龙
慢性阻塞性肺疾病%急性加重期%高齡%佈地奈德%甲彊龍
만성조새성폐질병%급성가중기%고령%포지내덕%갑강룡
chronic obstructive pulmonary disease%acute exacerbation%elderly%budesonide%methylprednisolone
目的:探讨不同激素方案治疗高龄慢性阻塞性肺疾病患者急性加重期( AECOPD)的临床疗效。方法:90例高龄AECOPD患者随机分为3组,每组各30例,均给予吸氧、抗生素、祛痰药、支气管扩张剂等常规治疗;雾化组给予布地奈德混悬液2 mg雾化吸入,每8 h一次;静脉组给予甲基强的松龙针剂40 mg静脉推注,每日1次;对照组不使用激素。7 d为一疗程。比较3组的疗效、MRC评分、血气分析、肺功能、空腹血糖、餐后血糖和不良反应。结果:治疗后,雾化组和静脉组的总有效率、呼吸困难评定分级均显著高于对照组( P<0.05);3组肺功能指标FEV1 Fred和血气分析各指标均有明显改善,雾化组、静脉组各指标显著优于对照组( P<0.05);雾化组血糖升高率与对照组无明显差别,静脉组的血糖升高率均显著高于对照组和雾化组( P<0.05)。雾化组不良反应发生率与对照组无明显差异,静脉组的发生率均显著高于对照组和雾化组( P<0.05)。结论:雾化吸入高剂量激素、全身静脉激素对AECOPD高龄患者疗效相当,均能明显改善患者的肺功能和动脉血气,雾化吸入激素的全身不良反应更低,建议可取代静脉激素作为AECOPD高龄患者的首选治疗方案。
目的:探討不同激素方案治療高齡慢性阻塞性肺疾病患者急性加重期( AECOPD)的臨床療效。方法:90例高齡AECOPD患者隨機分為3組,每組各30例,均給予吸氧、抗生素、祛痰藥、支氣管擴張劑等常規治療;霧化組給予佈地奈德混懸液2 mg霧化吸入,每8 h一次;靜脈組給予甲基彊的鬆龍針劑40 mg靜脈推註,每日1次;對照組不使用激素。7 d為一療程。比較3組的療效、MRC評分、血氣分析、肺功能、空腹血糖、餐後血糖和不良反應。結果:治療後,霧化組和靜脈組的總有效率、呼吸睏難評定分級均顯著高于對照組( P<0.05);3組肺功能指標FEV1 Fred和血氣分析各指標均有明顯改善,霧化組、靜脈組各指標顯著優于對照組( P<0.05);霧化組血糖升高率與對照組無明顯差彆,靜脈組的血糖升高率均顯著高于對照組和霧化組( P<0.05)。霧化組不良反應髮生率與對照組無明顯差異,靜脈組的髮生率均顯著高于對照組和霧化組( P<0.05)。結論:霧化吸入高劑量激素、全身靜脈激素對AECOPD高齡患者療效相噹,均能明顯改善患者的肺功能和動脈血氣,霧化吸入激素的全身不良反應更低,建議可取代靜脈激素作為AECOPD高齡患者的首選治療方案。
목적:탐토불동격소방안치료고령만성조새성폐질병환자급성가중기( AECOPD)적림상료효。방법:90례고령AECOPD환자수궤분위3조,매조각30례,균급여흡양、항생소、거담약、지기관확장제등상규치료;무화조급여포지내덕혼현액2 mg무화흡입,매8 h일차;정맥조급여갑기강적송룡침제40 mg정맥추주,매일1차;대조조불사용격소。7 d위일료정。비교3조적료효、MRC평분、혈기분석、폐공능、공복혈당、찬후혈당화불량반응。결과:치료후,무화조화정맥조적총유효솔、호흡곤난평정분급균현저고우대조조( P<0.05);3조폐공능지표FEV1 Fred화혈기분석각지표균유명현개선,무화조、정맥조각지표현저우우대조조( P<0.05);무화조혈당승고솔여대조조무명현차별,정맥조적혈당승고솔균현저고우대조조화무화조( P<0.05)。무화조불량반응발생솔여대조조무명현차이,정맥조적발생솔균현저고우대조조화무화조( P<0.05)。결론:무화흡입고제량격소、전신정맥격소대AECOPD고령환자료효상당,균능명현개선환자적폐공능화동맥혈기,무화흡입격소적전신불량반응경저,건의가취대정맥격소작위AECOPD고령환자적수선치료방안。
Objective:To compare the efficacy of different routes of corticosteroid administration for the treatment of acute exacerbation of chronic obstructive pulmonary disease ( AECOPD ) in elderly patients. Methods:Ninty elderly patients with AECOPD were randomly assigned to be treated with, on the basis of conventional regimens containing oxygen inhalation, antibiotics, mucolytics and bronchodilators, 2 mg of budesonide nebulization every 8 hours ( nebulization group, n=30 ), 40 mg methylprednisolone intravenous injection once daily ( the intravenous group,n=30) or nil corticosteroid ( control group,n=30) . An individual therapeutic course was consisted of 7 days. Following three consecutive courses, we assessed the efficacy, MRC score,blood-gas analysis,lung function,fasting plasma glucose,postprandial blood glucose and adverse events. Results:The total effectiveness rates in nebulization group and intravenous group were significantly higher than that in the control group ( both P<0.05) . Lung function ( FEV1 pred%) and blood-gas indices was unanimously improved in the three groups, with a greater magnitude of improvement in nebulization group and intravenous group ( both P<0.05) . The increase in blood glucose level in nebulization group,but not intravenous group ( P<0.05), was not significantly different than the control group ( P>0. 05 ) . Compared with control group, the incidence of adverse events was similar in nebulization group,but not intravenous group ( P<0.05) . Conclusion:A similar effect of high-dose nebulization and intravenous corticosteroid therapy, in terms of improvement in the lung function and blood-gas analysis indices,could be achieved for the treatment of AECOPD in elderly patients. Nebulization of corticosteroid is associated with minor systemic adverse events and could be recommended as the first-line regimen for AECOPD in elderly patients.