不同剂量糜蛋白酶雾化吸入治疗老年慢性阻塞性肺疾病急性加重期疗效观察

Clinical effect comparison between different dosages of chymotrypsin atomizing inhalation in treatment for elder patients with chronic obstructive pulmonary disease in acute exacerbation

目的比较观察不同剂量糜蛋白酶雾化吸入治疗老年慢性阻塞性肺疾病急性加重期的临床疗效和安全性。方法将88例老年慢性阻塞性肺疾病急性加重期患者按随机数字表法均为3组,其中对照组28例给予吸氧、抗感染及对症等常规治疗,糜蛋白酶高剂量和低剂量组各30例,分别在对照组常规治疗的基础上,加用α糜蛋白酶4 000U和8 000U,每日2次进行雾化吸入治疗,比较观察3组患者治疗前后的临床主要症状、体征、肺功能、临床疗效及不良反应的发生情况。结果 1临床症状比较:糜蛋白酶组气促、喘息缓解、咳痰和湿啰音消失时间均明显优于对照组(P<0.05),且高剂量组除湿啰音消失时间外,其他症状消失时间均优于低剂量组(P<0.05);2肺通气功能指标:糜蛋白酶组肺通气功能指标第1秒用力呼气容积(FEV1),FEV1占预计值百分比(FEV1%),用力肺活量(FVC)和呼气峰流速(PEF)改善情况均优于对照组(P<0.05),且高剂量组改善情况优于低剂量组(P<0.05);3显效率比较:高剂量组(90%)、低剂量组(77%)与对照组(39%)比较差异均有统计学意义(P<0.05);且高剂量组与低剂量组比较差异有统计学意义(P<0.05)。各组在治疗过程中均未发现明显不良反应。结论糜蛋白酶雾化吸入治疗老年慢性阻塞性肺疾病急性加重期患者均有一定疗效,且高剂量组的疗效优于低剂量组,在治疗过程中均未发现明显不良反应。

Objective To discuss the clinical effect of different dosages of chymotrypsin atomizing inhalation in treatment for elder patients with chronic obstructive pulmonary disease in acute exacerbation .Methods Eighty‐eight elderly patients of acute exacerbation of chronic obstructive pulmonary disease were chosen and random 1y di‐vided into control group ,small dosage（ n= 30 ） and large dosage（ n=30） of chymotrypsin group .Twenty‐eight cases in the control group were given oxygen ,anti‐infection and symptomatic and other conventional treatment . Small dosage and large dosage of chymotrypsin group were given alpha chymotrypsin 4 000 U and 8 000 U ,twice a day for inhalation therapy based on routine treatment .Changes of the main clinical symptoms ,pulmonary func‐tion ,clinical curative effect and adverse reaction before and after treatment were recorded .Results On comparison of developments of individual symptoms of different dosages of chymotrypsin groups after treatment .① The main symptoms disappear time （shortness of breath ,wheezing relieving ,sputum and wet rale） of chymotrypsin group was significantly better than that of the control group （ P〈0 .05） ,and except rale disappear time ,the large dosage better than the small dosage group（ P〈0 .05） .②Pulmonary function parameters FEV1 ,FEV1% ,FVC and PEF of chymotrypsin group were significantly better than those in the control group （ P 〈0 .05） ,and the large dosage better than the small dosage group（ P 〈0 .05） .③ The significant efficiency of large dosage chymotrypsin ,small dosage chymotrypsin and control group were 90% ,77% and 39% ,respectively .The large dosage chymotrypsin was obviously higher than the other two groups（ P〈0 .05） .Each group in the course of treatment were not found obvious adverse reaction .Conclusion The chymotrypsin atomizing inhalation has significant clinical effect in treat‐ment for elder patients with chronic obstructive pulmonary disease in acute exacerbation .There is a positive corre‐lation between its dosage and clinical effect.