雾化吸入高剂量表面激素与全身静脉激素治疗高龄AECOPD患者的疗效对比

Nebulized high-dose corticosteroids versus intravenous corticosteroids for acute exacerbation of chronic obstructive pulmonary disease

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40mmg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FEV_1Fred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,静脉纽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。

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(FEV_1 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.