支气管扩张伴喘息发作的临床研究

A Clinical Research on Bronchiectasis with Asthma

目的探讨支气管扩张伴喘息发作患者临床特点和肾上腺皮质激素治疗效果。方法 106例患者随机分为治疗组56例,对照组50例。治疗组在常规治疗基础上应用地塞米松或甲基强的松龙治疗。出院后吸入布地奈德气雾剂,起始剂量为400ug,每天2次,逐渐减量,总疗程6个月。对照组只给予常规治疗,不应用肾上腺皮质激素。结果两组患者FVE1/FVC%治疗后及出院后第3个月和第6个月与治疗前比较,均明显改善(P<0.05)。治疗组患者FVE1/FVC%治疗后较对照组改善更明显(P<0.05),但出院后第3个月和第6个月后两组患者FVE1/FVC%改善比较无差异性(P>0.05)。两组治疗失败率及住院天数比较,均有显著性差异(P<0.05)。两组病例动脉血氧分压治疗后差值及复发率比较,差异无统计学意义(P>0.05)。治疗组激素副作用发生率为16.07%。对照组无激素副作用发生,两组比较有极显著差异(P<0.01)。结论支气管扩张伴喘息发作是支气管广泛破坏,气道固定狭窄,感染加重气道黏膜充血水肿而出现的喘息。肾上腺皮质激素在支气管扩张伴喘息发作加重期,可明显改善患者肺功能、缩短住院时间和降低治疗失败率。但在稳定期应用表面激素并不能改善患者肺功能及降低复发率,而且会增加激素的副作用。

[Objective] This research was to probe into the clinical characteristic of bronchiectasis with asthma and the effect of the treatment with adrenal cortex hormone.[Methods] 106 patients were divided into two groups---56 for the treatment group and 50 for the control group.The treatment group uesed dexamethasone or methylprednisolone in the routine treatment.Out of hospital,the patients inspired budesonide,400ug for the beginning,2 times a day,gradually decreasing.The total treatment course was 6 months.The control group were only given the routine treatment,using not any adrenal cortex hormone.[Results] FVE1/FVC% of the two groups were improved obviously（P0.05）compared with the post-treatment and post-hospital in the third month and the sixth month.But FVE1/FVC% of the treatment group were improved more than the control group（P0.05）after the treatment.But in the third month and the sixth month out of hospital,FVE1/FVC% of the two groups had no difference（P0.05）.The failure rate and the hospital days of the two groups had a remarkable difference（P0.05）.After the artery blood oxygen differential pressure treatment,the difference between the two groups had no statistics significance（P0.05）.The hormone side effect rate of the treatment group was 16.07%,and the control group had no hormone side effect happening.So the two groups had a remarkable difference（P0.01）.[Conclusions] Bronchiectasis with asthma occurred when the bronchial tube received a widespread destruction,the gas channel fixed narrow and infection aggravated the gas channel mucous hyperemia and dropsy.In the bronchiectasis with asthma aggravating period,adrenal cortex hormone could improve lung function,shorten hospital time and cut down the treatment failure rate.But in the stable period,using superficial hormone could not improve lung function and could not cut down the recurrent rate.And it would increase the side effect of hormone.