全身性糖皮质激素在AECOPD合并高碳酸血症患者的应用分析

The Application of Systemic Corticosteroids in Patients with AECOPD Complicated with Hypercapnia

目的:探讨慢性阻塞性肺病急性加重(AECOPD)患者合并高碳酸血症情况下,使用全身性糖皮质激素的临床疗效。方法:采集笔者所在医院2013年4月-2016年2月收治的AECOPD患者80例,血气分析结果均显示Pa CO2≥50 mm Hg,分为使用激素组(A组)和未使用激素组(B组),每组40例。A、B两组患者均采用静脉抗感染与解痉平喘治疗,A组在上述基础上加用糖皮质激素治疗,同时服用质子泵抑制剂(PPI)以保护胃黏膜。观察各组第1、3、10天血气分析变化及治疗后第3、10天的肺功能情况,并比较两组的平均住院天数。结果:使用激素组(A组),在治疗第3天,Pa CO2水平较第1天明显下降,且下降幅度较未使用激素组(B组)第3天明显,比较差异均有统计学意义(P<0.05)。B组在治疗第10天Pa CO2水平才出现明显下降,但仍明显高于A组第10天Pa CO2水平,比较差异均有统计学意义(P<0.05)。A、B两组Pa O2水平在第3、10天均较治疗前出现明显的上升,比较差异均有统计学意义(P<0.05)。在治疗第3、10天,A组FEV1、FEV1/FVC均较B组明显改善,差异均有统计学意义(P<0.05)。A组平均住院天数比B组明显有所缩短,差异有统计学意义(P<0.05)。结论:对于AECOPD患者,如合并高碳酸血症,早期使用全身性糖皮质激素有助于改善患者的通气及氧合,改善肺功能及缩短住院时间。

Objective： To investigate the clinical efficacy of systemic corticosteroids in the treatment of AECOPD patients complicated with hypercapnia. Method： Eighty AECOPD patients in our hospital from April 2013 to February 2016 were collected as the objects, the blood gas analysis results showed that all patients＇ PaCO2 was more than or equal to 50 mm Hg, the patients were divided into the hormone group（group A） and the without hormone group（group B）, 40 patients in each group.Both of the two groups were given anti-infection and antiasthma treatment, while group A was recieved systemic corticosteroids in addition. The changes of blood gas analysis Were observed in the first, third and tenth days of each group and the pulmonary function was observed in third and tenth days after treatment in each group.The average hospitalization days were compared between the two groups.Result： The PaCO2 levels of the hormone group（group A） decreased significantly in the third day, which decreased more obviously compared with the group B, the difference was statistic significant（P〈0.05）.The PaCO2 levels of group B had no significantly decreased until the tenth day, but it was still significantly higher than which at the lOth day in the group A, the differences were statistically significant（P〈0.05）.The PaO2 levels in both two groups at the third day and the tenth day were significantly increased, the differences were statistically significant（P〈0.05）.At the third day and the tenth day in the treatment, the levels of FEV1 and FEV1/FVC of group A were better than those in the group B, the differences were statistically significant（P〈0.05）.The average length of stays in group A was shorter than that in the group B, the difference was statistic significant（P〈0.05）.Condusion： For the AECOPD patients combined with hypercapnia, the application of systemic cortieosteroids in early period helps to improve the ventilation and oxygenation, improve the lung function and shorten the hospital stays.