重度慢性阻塞性肺疾病急性加重期的糖皮质激素治疗

Glucocorticosteroid therapy in acute exacerbation of severe chronic obstructive pulmonary disease

目的探讨重度慢性阻塞性肺疾病(COPD)伴有慢性呼衰、慢性心肺功能不全患者急性加重期,使用糖皮质激素治疗的疗效及意义。方法随机选择重度COPD急性加重期患者29例,比较治疗前,常规抗感染、平喘、抗心衰治疗及加用激素治疗后生活质量,呼吸困难程度变化。结果呼吸困难评分:(1)治疗前3.78±0.41,(2)抗感染、平喘、抗心衰治疗后3.63±0.49,(3)激素治疗后2.8±0.37,(3)与(1)(2)差别有统计学意义(P<0.05)。生活质量评分:(1)治疗前9.26±2.31,(2)抗感染、平喘、抗心衰治疗后8.47±1.98,(3)激素治疗后5.89±1.72,(3)与(1)(2)差别亦有统计学意义(P<0.05)。结论重度COPD伴有慢性呼吸衰竭、慢性心肺功能不全患者,可能存有肾上腺皮质功能减退,适当使用糖皮质激素治疗有一定疗效。

Objective To evaluate the curative effect and significance of glucocorticosteroid therapy in acute exacerbation of severe chronic obstructive pulmonary disease （COPD）, Methods Twenty-nine patients with acute exacerbation of severe COPD were randomly selected to compare change of the quality of life and degree of dyspnea before treatment and after usual treatment （e.g. anti-infection, antiasthmatie and heat failure therapy） and increase with glucocorticosteroid besides aforesaid programmes . Results The comparison results showed the degree of dyspnea score before treatment was 3.78 ± 0.41, after usual treatment 3.63 ± 0.49, and increase with glucocorticosteroid 2.8 ± 0.37, and the guality of life score was 9.26 ± 2.31,8.47 ± 1.98, and 5.89 ± 1.72 separately, only after glucocorticosteroid therapy the improvement of quality of life and degree of dyspnea have statistical significance（P〈0.05）. Conclusion The patients with acute exacerbation of severe COPD who were accompanied by chronic respiratory failure and cardiorpulmonary function insufficiency might occur hypoadrenocorticism, so they should be given drug glucocorticosteroid and our data showed that glucocorticosteroid therapy gots good results.