吸入激素与口服激素治疗高原急性重症哮喘的对比观察

Comparative study on therapeutic effects of inhaling or oral corticosteroid on acute severe asthma at plateaus

目的：观察吸入激素布地奈德治疗高原急性重症哮喘的效果。方法：４０ 例急性重症哮喘随机分为两组：吸入布地奈德组２０ 例，１ ２００～１ ６００ μｇ／ｄ；口服强的松组２０ 例，４０ ｍｇ／ｄ。治疗前和治疗后１、３、５ 、７、１０ ｄ 分别测呼气峰流速（ＰＥＦ）。结果：治疗１ ｄ，两组ＰＥＦ％ 预计值均显著增高，ＰＥＦ日变异率显著降低（Ｐ＜ ０．０５）；治疗３ ｄ，ＰＥＦ％ 预计值非常显著性增高，ＰＥＦ日变异率非常显著性降低（Ｐ＜０ ．０１） 。此后分别继续增高和降低，至第１０ 天吸入激素组和口服激素组ＰＥＦ％ 预计值分别由治疗前的４１．７％ ±９．２％ 增至８７ ．６％ ±１１．３ ％ 和４２．３％ ±９．５ ％ 增至８４ ．０％ ±１０．２％ ，ＰＥＦ日变异率由３３．７％ ±１２．８％ 降至７．２％ ±４ ．０ ％ 和由３５．５％ ±１５．１％ 降至８．１％ ±５．２％ 治疗前后两组之间无显著性差异（ Ｐ＞ ０．０５） 。吸入激素组治疗１ ｄ，症状明显缓解，３ ｄ 全部控制。口服激素组除１ 例在治疗第２ 天病情恶化加用地塞米松１０ ｍｇ 静注后控制，其余１９ 例均在治疗后１ ｄ 症状明显缓解，３ ｄ 全部控制。结论：吸入激素布地奈德气雾剂治疗高原急性重症哮喘有显?

Purpose:To evaluate the therapeutic effects of inhaling corticosteroid(budesonide) on acute severe asthma at plateaus.Methods:40 acute severe asthma patients were randomly divided into two groups:group 1( n =20) inhaled budesonide 1 200-1 600 μg/d;group 2( n =20) orally received prednisone 40 mg/d.After improvement of symptoms,the doses were gradually decreased,up to the 10th day,the former was decreased to 800 μg/d and the latter 10 mg/d.peak expiratory flow(PEF)was measured before and 1,3,5,7,10 days after treatment.Results:After one day of treatment,the predicate PEF% values in two groups were all increased significantly and the PEF daily change rate decreased obviously(all P <0.05).At the 10th day,in group 1,the former increased from 41.7%±9.2% to 87.6%±11.3% and the latter decreased from 33.7%±12.8% to 7.2%±4.0%(all P <0.01)and in group 2,the former increased from 42.3%±9.5% to 84.0%±10.2%,the latter decreased from 35.5%±15.1% to 8.1%±5.2%(all P <0.01).But there were no differences between these indexes of two groups before and after treatment(all P >0.05).Symptoms in 20 cases of group 1 and 19 of group 2 relieved at the 3rd day of treatment.Conclusion:Inhaling of budesonide is a very effective method for the treatment of acute severe asthma at plateaus.Its effects are same as those of oral prednisone treatment.