不同用药方案治疗慢性阻塞性肺疾病急性加重期的效果观察

Efficacy observation of different regimens in treatment of chronic obstructive pulmonary disease with acute exacerbation

目的观察吸入用布地奈德混悬液分别与硫酸特布他林、异丙托溴铵联合经氧气驱动雾化吸入治疗慢性阻塞性肺病急性加重期（AECOPD）的临床效果。方法选取本院呼吸内科2013年11月~2014年6月住院的AECOPD患者136例,随机分为硫酸特布他林组、异丙托溴铵组和对照组。硫酸特布他林组给予吸入用布地奈德混悬液1 mg和硫酸特布他林5 mg氧气驱动雾化吸入,2次/d;异丙托溴铵组给予吸入用布地奈德混悬液1 mg和异丙托溴铵0.5 mg氧气驱动雾化吸入,2次/d;对照组常规给予地塞米松10 mg静滴,1次/d10观察3组患者治疗7 d后的临床效果,治疗前后动脉血气和肺功能的变化及副作用情况。结果硫酸特布他林组的总有效率为91.67%,异丙托溴铵组的总有效率为86.36%,均明显高于对照组的65.91%,差异有统计学意义（P〈0.05）。治疗7 d后,3组患者的第1秒用力呼气容积（FEV1）及第1秒用力呼气容积占用力肺活量百分比（FEV1/FVC）均较治疗前改善（P〈0.05）,且硫酸特布他林组、异丙托溴铵组改善幅度较对照组更明显（P〈0.05）。与治疗前比较,3组患者的动脉血氧分压（Pa O2）提高,动脉血二氧化碳分压（Pa CO2）下降,差异有统计学意义（P〈0.05）;且硫酸特布他林组、异丙托溴铵组改善幅度较对照组更明显（P〈0.05）。硫酸特布他林组出现咽喉不适1例,轻微心悸2例;异丙托溴铵组出现咽喉不适2例,头痛1例;对照组出现恶心呕吐3例,黑便2例,血糖升高6例。结论吸入用布地奈德混悬液分别与硫酸特布他林、异丙托溴铵联合用药经氧气雾化吸入治疗AECOPD均能快速缓解病情及减少不良反应发生,疗效确切,值得临床推广。

Objective To investigate the clinical efficacy of budesonide suspension for inhalation combined with terbutaline sulfate and ipratropium bromide respectively in treatment of chronic obstructive pulmonary disease with acute exacerbation （AECOPD）. Methods 136 cases of patients with AECOPD treated in our hospital from November 2013 to June 2014 were selected,and were randomly divided into terbutaline sulfate group,ipratropium bromide group and control group.Terbutaline sulfate group were taken with 1 mg budesonide suspension for inhalation and 5 mg terbutaline sulfate oxygen drive inhalation,2 times a day;Ipratropium bromide group were taken with 1 mg budesonide suspension for inhalation and 0.5 mg ipratropium bromide oxygen drive inhalation,2 times a day;control group were taken with 10 mg dexamethasone,intravenous infusion,one time a day.The clinical effect after 7 days treatment was compared,arterial blood gas and pulmonary function changes before and after treatment was observed. Results The total effective rate of terbutaline sulfate group was 91.67%,ipratropium bromide group was 86.36%,both higher than 65.91% of control group, the difference was significant （P〈0.05）.After 7 days treatment,FEV1 and FEVI/FVC of 3 groups improved compared with before treatment （P〈0.05）,and terbutaline sulfate group,ipratropium bromide group improved more than that of control group （P〈0.05）.Compared with before treatment,PaO2 of 3 groups increased,PaCO2 decreased,the difference was signifi- cant （P〈0.05）;and terbutaline sulfate group,ipratropium bromide group improved more than that of control group （P〈 O.05）.There were 1 case of throat discomfort,2 cases of slight palpitations in terbutaline sulfate group;2 cases of throat discomfort,1 case of headache in ipratropium bromide group;3 cases of nausea and vomiting,2 cases of melena,6 cases of hyperglycemia in control group. Conclusion Budesonide suspension for inhalation combined with terbutaline sulfate and ipratropium bromide respectively in treatment of AECOPD can quickly alleviate the condition and reduce the inci- dence of adverse reactions,with the acute efficacy,therefore is worthy of clinical promotion.