不同剂量的甲泼尼龙琥珀钠对重症哮喘患者的疗效及毒副作用观察

Therapeutic effects and side effects of different doses of methylprednisone on severe asthma

目的观察不同剂量的甲泼尼龙对重症哮喘患者的疗效及其毒副作用。方法选取2014年5月至2016年5月就诊的重症哮喘患者64例,随机分为对照组、观察组A、观察组B、观察组C,每组16例。对照组采用地塞米松(0.3~0.5 mg·kg^(-1)·d^(-1)治疗,观察组A、观察组B、观察组C分别采用甲泼尼龙(1~1.5 mg·kg^(-1)·d^(-1))、甲泼尼龙(2~4 mg·kg^(-1)·d^(-1))、甲泼尼龙(6~8 mg·kg^(-1)·d^(-1))治疗,观察并比较不同剂量甲泼尼龙对重症哮喘患者的治疗总有效率、治疗前后PaO_2及PaCO_2、症状和体征改善时间、毒副作用。结果观察组A、观察组B、观察组C治疗重症哮喘的总有效率显著高于对照组(P<0.05),观察组B、观察组C治疗重症哮喘的总有效率显著高于观察组A(P<0.05);观察组A、观察组B、观察组C的PaO_2显著高于对照组(P<0.05),PaCO_2显著低于对照组(P<0.05);观察组B的PaO_2显著高于观察组A(P<0.05),观察组C的PaO_2显著高于观察组B(P<0.05);观察组A、观察组B、观察组C症状和体征改善时间显著低于对照组(P<0.05);观察组B体征控制时间显著低于观察组A(P<0.05),观察组C体征控制时间显著低于观察组B(P<0.05);观察组A、观察组B、观察组C的上消化道出血率、血糖、血压显著高于对照组(P<0.05);观察组C的血糖、血压显著高于观察组A、观察组B(P<0.05)。结论采用2~4 mg·kg^(-1)·d^(-1)剂量的甲泼尼龙治疗重症哮喘患者效果好,不良反应低,值得推广应用。

Objective To observe the therapeutic effects and side effects of different doses of methylprednisone on severe asthma. Methods Sixty-four patients with severe asthma who were treated in our hospital from May 2014 to May 2016 were randomly divided into control group,observation group A,observation group B,observation group C,with 16 patients in each group. The patients in control group were treated by dexamethasone（ 0. 3 ～ 0. 5mg·kg^-1·d^-1）,however,the patients in observation group A,B,C were treated by methylprednisolone of 1 ～ 1. 5mg · kg^-1·d^-1,2 ～ 4mg·kg^-1·d^-1,6 ～8mg·kg^-1·d^-1,respectively. The total effective rate,PaO2 and PaCO2,improvement time of symptoms and signs,toxic and side effects were observed and compared among the four groups. Results The total effective rate in observation group A,B,C was significantly higher than that in control group（ P〈0. 05）,which in observation group B and group C was significantly higher than that in group A（ P〈0. 05）. The PaO2 in observation group A,B,C was significantly higher than that in control group（ P〈0. 05）,however,the PaCO2 in the three groups was significantly lower than that in control group（ P〈0. 05）.The PaO2 in observation group B was significantly higher than that in group A（ P〈0. 05）,moreover,PaO2 in observation group C was significantly higher than that in group B（ P〈0. 05）. The improvement time of symptoms and signs in observation group A,B,C was significantly shorter than that in control group（ P〈0. 05）,and the improvement time in observation group B was significantly shorter than that in group A（ P〈0. 05）,moreover,which in group C was significantly shorter than that in group B（ P〈0. 05）. The incidence rate of upper gastrointestinal bleeding,the levels of blood glucose and blood pressure in observation group A,B,C were significantly higher than those in control group（ P〈0. 05）,moreover,the levels of blood glucose and blood pressure in observation group C were significantly higher than those in group A and group B（ P〈0. 05）.Conclusion The methylprednisolone at the dose of 3 ～ 4mg · kg^-1· d^-1has satisfactory therapeutic effects on severe asthma,with few side effects,therefor,which is worth using widely in clinical practice.