甲基强地松龙序贯治疗慢性阻塞性肺疾病急性发作患者的研究

Study of sequential therapy on the patients of COPD-AE with methylprednisolone

目的 :评价甲基强地松龙 (甲强龙 )序贯治疗重度和危重度慢性阻塞性肺疾病急性发作(COPD- AE)的疗程、疗效及药物经济学。方法 :随机平行对照、开放、多中心研究 ,重度、危重度COPD急性发作住院患者 16 1例。A、B组应用甲强龙 80mg静脉滴注bid ,4d后口服甲强龙片 8mgbid ,A组 5d ,B组 10d ;C组口服甲强龙片 16mgbid 14d。 3组均同步应用抗生素、支气管扩张剂及祛痰药。结果 :3组治疗后症状评分、1s用力呼气容积 (FEV1 )、FEV1 %、氧分压 (PaO2 )、二氧化碳分压 (PaCO2 )均较治疗前显著改善 ,3组间比较差异均无显著性。A、B组治疗中期及治疗后用力肺活量 (FVC)显著增加。治疗后A、B、C组病情改善率分别为 5 1. 5 %、4 8. 4 %和 39 .4 %。A、B组症状体征起效时间为 2d ,但仅咳嗽症状改善显著快于C组。A组 9d疗程药费为 372 3 3元显著低于B组 (5 4 94元 )和C组 (5 0 4 1 .1元 ) ,同时陪护费、误工费减少 5d。结论 :甲强龙序贯治疗 9d与序贯治疗 14d或口服 14d疗效相似 ,且起效快、费用低 ,值得推广。

Objective：To evaluate the clinical course, effect, and drug economy sequential therapy on the patients of COPD-AE with methylprednisolone. Method： We adopted random, parallel, open, control muhicentre study. The 116 patients of severe COPD-AE were separated into A, B, and C groups. Methylprednisolone was given 80 mg, VD., b. i.d. in A and B groups. After 4 days, 8 mg of methylprednisolone table was given, P. O., b. i. d. for 5 days in A group, 10 days in B group. 16 mg of methylprednisolone table was given, P. O., b. i. d. from 1st to 14^th day. The antibiotics, bronchodilators, and apophlegmatisant were given routinely. Result： The symptomatic score, FEV1 , FEV1 %, PaO2 and PaCO2 improved contrasting to pre-treatment. However three groups was no significant difference. The FVC increased markedly in A and B group at the middle and end of treatment. The improved rates of A, B, and C group were 51.5 % ,48.4 % , and 39.4 % respectively. The improvement of only cough was faster in A and B group than in C group though the effect of symptoms and signs at 2nd after treatment in A and B group. The clinical cost was 3723.3 Yuan in A group,markedly less than 5494 Yuan in B group and 5041.1 Yuan in C group. Conclusion：The method of methylprednisolone sequential therapy for 9 days was worth to be extended because of the similar effect among methylprednisolone sequential therapy for 9 days, methylprednisolone sequential therapy for 14 days, and oral administration 14 days, faster effect, and less clinical cost.