大剂量氨溴索联合抗生素治疗老年慢性阻塞性肺疾病合并重症肺炎的疗效

Effects of ambroxol combined with antibiotic on chronic obstructive pulmonary disease complicated with severe pneumonia in elderly

目的观察大剂量氨溴索联合抗生素对老年慢性阻塞性肺疾病(COPD)合并重症肺炎病人肺功能、血气指标、炎症因子的影响。方法将129例老年COPD合并重症肺炎病例随机分为观察组(67例)和对照组(62例)。对照组在常规治疗的基础上给予抗生治疗及常规剂量氨溴索,观察组在常规治疗基础上给予抗生素治疗及大剂量氨溴索。治疗7 d,观察2组一秒钟用力呼气量(FEV1)、肺活量(FVC)、肺活量25%时的呼气流速(PEF25)、肺活量50%时的呼气流速(PEF50)、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)及高敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)的变化。结果 (1)2组肺功能指标FEV1、PEF25、PEF50以及FVC水平比较差异有统计学意义(P<0.05);2组肺功能各指标随着时间的延长逐渐升高(P<0.05),观察组升高的幅度大于对照组(P<0.05);(2)2组血气指标PaO_2、PaCO_2、p H值水平比较差异有统计学意义(P<0.05);2组PaO_2、p H值随着时间的延长逐渐升高(P<0.05),而PaCO_2逐渐降低(P<0.05),观察组PaO_2、p H值升高的幅度以及PaCO_2降低幅度均大于对照组(P<0.05);(3)2组血清炎症因子CRP、TNF-α以及IL-6、IL-8水平比较差异有统计学意义(P<0.05);2组各炎症因子水平随着时间的延长逐渐降低(P<0.05),观察组降低的幅度大于对照组(P<0.05)。2组均无严重不良反应。结论大剂量氨溴索配合抗生素治疗老年COPD合并重症肺炎,能更有效快速恢复肺功能、改善血气指标以及抑制炎症反应。

Objective To observe the effects of large dose of ambroxol combined with antibiotics on pulmonary function, blood gas index and inflammatory factors in elderly patients with chronic obstructive pulmonary disease（ COPD） complicated with severe pneumonia. Methods 129 cases of elderly patients with COPD complicated with severe pneumonia were randomly divided into the observation group（ 67 cases） and the control group（ 62 cases）. The control group was given antibiotics and voutine dose of ambroxol based on conventional treatment,and the observation group was given antibiotics and large dose of ambroxol based on conventional treatment for 7 days. The differences of pulmonary function,blood gas index and inflammatory factors between the two groups were compared.Results（ 1） There were significant differences in FEV1,PEF25,PEF50 and FVC between the two group（ P〈0. 05）,and all indexes increased at a time-dependent manner（ P〈0. 05）,and the increasing range of the observation group was higher than that of the control group（ P〈0. 05）.（ 2） There were significant differences in the levels of PaO2,PaCO2,p H between the two group（ P〈0. 05）. The levels of PaO2,p H increased and the level of PaCO2 decreased at a time-dependent manner（ P〈0. 05）. The change range of the observation group was larger than that of the control group（ P〈0. 05）.（ 3） There were significant differences in the levels of CRP,TNF-α,IL-6,IL-8 between the two group（ P〈0. 05）,and all indexse increased at a time-dependent manner（ P〈0. 05）, and the change range of the observation group was more than that of the control group（ P〈0. 05）. There were no statistical differences in adverse reaction between the two groups（ P〉0. 05）. Conclusions Large dose of ambroxol combined with antibiotic can effectively restore pulmonary function, improve blood gas index and inflammatory reaction in elderly patients with COPD complicated with severe pneumonia.