不同雾化方法吸入布地奈德在慢阻肺急性加重期疗效及血药浓度对比研究

Comparative analysis of curative effect of budesonide inhalation by different methods in the treatment of AECOPD patients

目的通过对慢性阻塞性肺疾病(慢阻肺)急性加重期疗效评估、血药浓度监测方式,对空气泵驱动雾化、氧驱动雾化及经无创呼吸机管道串联空气泵雾化器三种方式吸入布地奈德的各自特点进行评价。方法共入选42例慢阻肺急性加重期患者,其中18例采用空气泵驱动、14例采用氧驱动、10例合并Ⅱ型呼吸衰竭者采用无创呼吸机串接雾化器吸入布地奈德,对慢阻肺症状评分(CAT)、血气分析指标及血药浓度进行测定;另招募10例慢阻肺稳定期志愿者作为对照,5例采用1 mg布地奈德雾化吸入,另5例采用2 mg,分别在吸入完毕后10 min、30 min、60 min及120 min采血留取血样,行布地奈德血药浓度测定。结果空气泵驱动与氧驱动雾化对于非呼吸衰竭慢阻肺急性加重患者疗效相近,治疗前后症状改善明显,布地奈德血药浓度指标相近,但氧驱动雾化吸入者治疗后测定动脉二氧化碳分压较治疗前及空气泵驱动组升高;无创呼吸机串接雾化吸入者治疗前后改善明显,布地奈德血药浓度约为上述2种雾化吸入方法的70%;稳定期慢阻肺患者布地奈德血药浓度与前2种方法吸入者相近。结论对于非Ⅱ型呼吸衰竭的慢阻肺急性加重患者,采用空气泵驱动雾化吸入布地奈德较氧驱动雾化吸入更加安全;对于合并Ⅱ型呼吸衰竭需要行无创通气治疗者,经呼吸机管路串接空气泵驱动雾化器吸入是一种较为安全有效的方法,但如达到同样布地奈德吸收率可能需增大给药剂量。

Objective To assess the curative effect of budesonide inhalation by different methods in the treatment of AECOPD COPD patients. Methods 42 AECOPD patients were enrolled in this study, 18 of them ac-cepted sinus flow pump nebulized budesonide, 14 oxygen drived nebulizer, and 10 ventilator pipe series connected nebulizer. Another 10 COPD patients were given 1mg or 2mg sinus pump nebulized budesonide for control. Results The curative effect and blood concentration of budesonide were similar between the sinus flow pump group and the oxygen drived nebulized budesonide group, but the oxygen drived nebulizer group got a higher PaCO2 level than the sinus flow pump nebulizer group did after therapy. The ventilator pipe series connected nebulizer group got a lower plasma contration budesonide than the other 2 groups did. Conclusion Sinus flow pump nebulized budesonide is sa-fer than oxygen drived nebulizer for AECOPD who without hypercapnemia. For AECOPD patients complicated with type Ⅱ respiratory failure, ventilator pipe series connected nebulized budesonide is an effective and safe inhalation method.