CAJ | 학술논문

目的：比较观察不同剂量糜蛋白酶雾化吸入治疗老年慢性阻塞性肺疾病急性加重期的临床疗效和安全性。方法将88例老年慢性阻塞性肺疾病急性加重期患者按随机数字表法均为3组，其中对照组28例给予吸氧、抗感染及对症等常规治疗，糜蛋白酶高剂量和低剂量组各30例，分别在对照组常规治疗的基础上，加用α糜蛋白酶4000 U和8000 U ，每日2次进行雾化吸入治疗，比较观察3组患者治疗前后的临床主要症状、体征、肺功能、临床疗效及不良反应的发生情况。结果①临床症状比较：糜蛋白酶组气促、喘息缓解、咳痰和湿啰音消失时间均明显优于对照组（ P ＜0．05），且高剂量组除湿啰音消失时间外，其他症状消失时间均优于低剂量组（ P ＜0．05）；②肺通气功能指标：糜蛋白酶组肺通气功能指标第1秒用力呼气容积（FEV1），FEV1占预计值百分比（FEV1％），用力肺活量（FVC）和呼气峰流速（PEF）改善情况均优于对照组（ P ＜0．05），且高剂量组改善情况优于低剂量组（ P ＜0．05）；③显效率比较：高剂量组（90％）、低剂量组（77％）与对照组（39％）比较差异均有统计学意义（P ＜0．05）；且高剂量组与低剂量组比较差异有统计学意义（P ＜0．05）。各组在治疗过程中均未发现明显不良反应。结论糜蛋白酶雾化吸入治疗老年慢性阻塞性肺疾病急性加重期患者均有一定疗效，且高剂量组的疗效优于低剂量组，在治疗过程中均未发现明显不良反应。
목적：비교관찰불동제량미단백매무화흡입치료노년만성조새성폐질병급성가중기적림상료효화안전성。방법장88례노년만성조새성폐질병급성가중기환자안수궤수자표법균위3조，기중대조조28례급여흡양、항감염급대증등상규치료，미단백매고제량화저제량조각30례，분별재대조조상규치료적기출상，가용α미단백매4000 U화8000 U ，매일2차진행무화흡입치료，비교관찰3조환자치료전후적림상주요증상、체정、폐공능、림상료효급불량반응적발생정황。결과①림상증상비교：미단백매조기촉、천식완해、해담화습라음소실시간균명현우우대조조（ P ＜0．05），차고제량조제습라음소실시간외，기타증상소실시간균우우저제량조（ P ＜0．05）；②폐통기공능지표：미단백매조폐통기공능지표제1초용력호기용적（FEV1），FEV1점예계치백분비（FEV1％），용력폐활량（FVC）화호기봉류속（PEF）개선정황균우우대조조（ P ＜0．05），차고제량조개선정황우우저제량조（ P ＜0．05）；③현효솔비교：고제량조（90％）、저제량조（77％）여대조조（39％）비교차이균유통계학의의（P ＜0．05）；차고제량조여저제량조비교차이유통계학의의（P ＜0．05）。각조재치료과정중균미발현명현불량반응。결론미단백매무화흡입치료노년만성조새성폐질병급성가중기환자균유일정료효，차고제량조적료효우우저제량조，재치료과정중균미발현명현불량반응。
Objective To discuss the clinical effect of different dosages of chymotrypsin atomizing inhalation in treatment for elder patients with chronic obstructive pulmonary disease in acute exacerbation .Methods Eighty‐eight elderly patients of acute exacerbation of chronic obstructive pulmonary disease were chosen and random 1y di‐vided into control group ,small dosage( n= 30 ) and large dosage( n=30) of chymotrypsin group .Twenty‐eight cases in the control group were given oxygen ,anti‐infection and symptomatic and other conventional treatment . Small dosage and large dosage of chymotrypsin group were given alpha chymotrypsin 4 000 U and 8 000 U ,twice a day for inhalation therapy based on routine treatment .Changes of the main clinical symptoms ,pulmonary func‐tion ,clinical curative effect and adverse reaction before and after treatment were recorded .Results On comparison of developments of individual symptoms of different dosages of chymotrypsin groups after treatment .① The main symptoms disappear time (shortness of breath ,wheezing relieving ,sputum and wet rale) of chymotrypsin group was significantly better than that of the control group ( P<0 .05) ,and except rale disappear time ,the large dosage better than the small dosage group( P<0 .05) .②Pulmonary function parameters FEV1 ,FEV1% ,FVC and PEF of chymotrypsin group were significantly better than those in the control group ( P <0 .05) ,and the large dosage better than the small dosage group( P <0 .05) .③ The significant efficiency of large dosage chymotrypsin ,small dosage chymotrypsin and control group were 90% ,77% and 39% ,respectively .The large dosage chymotrypsin was obviously higher than the other two groups( P<0 .05) .Each group in the course of treatment were not found obvious adverse reaction .Conclusion The chymotrypsin atomizing inhalation has significant clinical effect in treat‐ment for elder patients with chronic obstructive pulmonary disease in acute exacerbation .There is a positive corre‐lation between its dosage and clinical effect.