不同剂量布地奈德治疗慢性阻塞性肺疾病急性加重期的疗效观察

Effects of different dosing regimens of inhaled budesonide suspension on acute exacerbations of COPD

目的探讨不同剂量布地奈德混悬液联合硫酸沙丁胺醇、异丙托溴铵雾化吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效。方法中重度AECOPD患者90例,随机分为3组。对照组给予硫酸沙丁胺醇5mg与异丙托溴铵500μg雾化吸入,观察1组联用布地奈德1mg,观察2组联用布地奈德2mg,均为1次/8h,连续治疗观察10d。3组均根据病情给予吸氧、抗生素、氨茶碱等常规治疗。结果观察2组症状体征改善有效率(93.3%)高于对照组(68.9%),P<0.01,高于观察1组(80.9%)。治疗后第5d,对照组、观察1组、观察2组第1s用力呼气容积(FEV1)分别增加10.0%、15.8%、23.7%,治疗10d后分别增加22.8%、29.4%、32.9%,观察2组增加高于观察1组(P<0.05)和对照组(P<0.01)。用力呼气容积(FVC)增加趋势相同。观察2组患者的SaO2在治疗48h较治疗前有显著增加(P<0.05),而观察1组及对照组72h后SaO2才有明显增加。直至观察终点,观察2组的SaO2增加较另两组更显著。治疗5d后观察1组疗效优于对照组(P<0.05)。结论联合雾化吸入布地奈德、硫酸沙丁胺醇与异丙托溴铵可明显改善AECOPD患者肺功能,提高患者生活质量。布地奈德2mg组较布地奈德1mg组症状及肺功能改善更快更好。

Objective This study investigated the clinical effects of different dosing regimens of inhaled budesonide （BUD） suspension through nebulizer in combination with ipratropium bromide and salbutamol on acute exacerbations of COPD（AECOPD）. Methods Ninety subjects with moderate to severe AECOPD were divided into three groups. The placebo group received ipratropium bromide 500 microg and salbutamol 5 mg,q8 h,on this base,the other two groups received BUD 1 mg or 2 mg addedly every time. The three groups were given oxygen,antibiotic drugs,aminophylline if necessary. The observation time was 10 days. Results 5 days after treatment,FEV1,FVC and SaO2 increased 10.0% ,15.8% ,23.7% in control,group 1 and 2,more significantly and quickly in group 2 than that in group 1 and control（P〈0.05）. SaO2 showed significant difference compared with pre-treatment after 48 hours treatment. However, SaO2 in other two groups showed significant difference only after 72 hours treatment. Until 5 days,SaO2,lung function and clinical syndrome had better improvement in group received BUD ling than that in placebo group. Conclusions Inhaled BUD suspension in combination with ipratropium bromide and salbutamol can improve more significantly and quickly the lung function,SaO2 and clinical syndrome of patients with AECOPD,espeeially in patients received BUD 2 mg,q8 h.