AECOPD中糖皮质激素序贯应用的观察

Observation of Sequential Therapy on Patients of AECOPD with Glucocorticosteroid

目的评价糖皮质激素序贯治疗中、重度慢性阻塞性肺疾病急性加重(AECOPD)的疗效及不良反应。方法临床确诊为中、重度COPD急性加重期并且符合入选标准的住院患者64例,随机分为A、B两组,均给予甲基强的松龙(甲强龙)静脉滴注,40 mg Bid,治疗3 d之后,A组给予雾化吸入普米克令舒,2 mg q12 h,治疗7 d。B组给予口服强的松片,30 mg qd,治疗7 d。两组患者在研究期间,同步应用吸氧、抗生素、支气管扩张剂、祛痰剂、营养支持治疗。用药后观察两组患者症状评分、肺功能及不良反应情况。结果 2组治疗后症状评分、第1 s用力呼气容积(FEV1)、FEV1%、血氧分压(PaO2)、二氧化碳分压(PaCO2)均较治疗前显著改善,两组之间差异无统计学意义。A组患者呼吸困难症状改善时间较B组快(P<0.05),不良反应观察中,B组有4例患者出现血糖轻度升高,A组患者未出现血糖异常。结论 COPD急性加重期的患者使用糖皮质激素治疗过程中,在全身用药见效后,及早改为局部雾化吸入治疗,其疗效与全程全身应用激素效果相似,可作为全程全身应用激素的替代治疗。

Objective To evaluate the effect and the side effect of sequential therapy on patients of morder- ate or severe acute exacerbation of chronic obstructive pulmonary disease（AECOPD） with glucocorticosteroid.Method 64 patients with morderate or severe AECOPD were separated into group A and group B randomly. All patients were given intravenous drip methylprednisolone 40mg, twice a day for 3 days, The group A were given inhaled budesonide 2 mg, twice a day for 7 days, Group B were given oral prednisone pills 30 mg per day for 7 day. Both group A and group B were given 02 inhalation, antibiotics, bronchodilators, apophlegmatisant and nutrition support therapy simultaneously. The symptomatic score, pulmonary function and side effect were observed in two groups. Result Compared with pretreatment the symptomatic score, FEV1, FEV1%, PaO2 and PaCO2 were improved in both group A and group B after the 10 days therapy（P 〈 0.05）. There were no significant difference between two groups（P 〈 0.05）. The improved time of the symptom of dyspnea in A froup is shorter than in B group. There were slight raise up of serum glucose in 4 patients in group B and none in group A. Conclusion Glucocorticosteroid are operative the treatment of patients with AECOPD, After the systemic administration are in effect, local application of inhaled glucocorticosteroid may have the resemble effect to systemic administration and can be a substitution therapy of systemic administration on AECOPD.