无创正压通气联合雾化吸入布地奈德治疗重症哮喘的效果观察

Effects of treatment with noninvasive positive pressure ventilation combined with aerosol inhalation budesonide on severe asthma

目的探讨无创正压通气联合雾化吸入布地奈德对重症哮喘患者的临床疗效。方法将121例重症哮喘患者随机分为两组，均在常规治疗的基础上进行无创正压通气治疗，布地奈德组同时给予雾化吸入布地奈德混悬液2ml＋生理盐水2ml，2次／d，14d为1个疗程。对治疗前后两组临床症状改善和血气分析变化情况进行对比性研究，观察疗效。结果治疗前布地奈德组与对照组pH、PaO2、PaCO2差异均无统计学意义（P均〉0．05），治疗1个疗程后，pH、PaO：高于对照组[（7．43±0．04）、（7．34±0．02）、t：3．423；（77．4±16．7）、（62．4±16．5）mmHg、t=3．414]，PaCO2低于对照组[（43．4±8．9）、（50．9±9．1）mm Hg、t=5．317]，差异均有统计学意义（P均〈0．05）。布地奈德组总有效率为96．7％（59／61），对照组为88．3％（53／60），差异有统计学意义（Х^2=4．218，P〈0．05）。结论临床上无创正压通气联合雾化吸入布地奈德治疗重症哮喘疗效显著，操作简单，值得推广。

Objective To investigate the curative effect of noninvasive positive pressure ventilation combined with aerosol inhalation of budesonide on patients with severe asthma. Methods One hundred and twenty-one patients with severe asthma were randomly assigned to two groups. Both groups were treated with noninvasive positive pressure ventilation based on routine treatment. In addition, patients in the treatment group were given aerosol inhalation of 2 ml budesonide and 2 ml NS, two times each day, 14 days for a course. Clinical symptoms improvement and arterial blood pressure changes of two groups before and after treatment were studied to compare the curative effect of the treatments in the two groups. Results There were no significant differences in pH,PaO2 and PaCO2 between the treatment and the control groups（P 〉 0. 05）. After one course of treatment, the treatment group had significantly higher levels of pH （7.43± 0.04 vs. 7. 34 ± 0.02, t = 3. 423, P 〈 0. 05 ） and PaO2 （ [ 77.4± 16. 7 ] mm Hg vs. [ 62. 4 ± 16. 5 ] mm Hg, t = 3.414, P 〈 0. 05 ） and lower levels of PaCO2 （ [43.4 ±8. 9 ] mm Hg vs. [ 50. 9 ± 9. 1 ] mm Hg, t = 5. 317, P 〈 0.05 ） than the control group. There were significant differences in the total effective rate between the Budesonide group and the control group （96.7% vs. 88.3 %, X^2 = g. 218, P 〈 0. 05 ）. Conclusion Noninvasive positive pressure ventilation combined with aerosol inhalation of budesonide is a simple and effective strategy for patients with severe asthma. Thus it may be worthy to be widely used clinically.