雾化吸入不同剂量布地奈德在治疗慢性阻塞性肺病急性加重期的疗效

Compared the effects of different doses of nebulized budesonide in the treatment of AECOPD

目的探讨雾化吸入不同剂量布地奈德治疗慢性阻塞性肺病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)的疗效差异。方法抽取2017年10月至2019年5月间,于我院呼吸内科住院的321例中重度AECOPD患者,随机分到以下3组雾化布地奈德,A组予4 mg/d(1 mg q6h,95例);B组(2 mg q6h,111例)及C组(4 mg q12h,115例)均予8 mg/d;对比3组患者的雾化前、雾化3 h及雾化5 d的CAT评分、肺功能、血气分析、住院时间、不良反应及出院3个月内急性加重次数。结果与治疗前相比,雾化3 h后C组FEV1%显著改善(P<0.05)。组间比较,雾化3 h后C组FEV1%改善幅度显著高于A组(P<0.05);雾化5 d后,在CAT评分、FEV1%、MEF50%、MEF25%~75%改善上,C组>B组>A组,其中,3组在FEV1%改善上均有差异(均P<0.05);在CAT评分、MEF50%、MEF25%~75%改善上,C组的改善幅度高于A组(P<0.05)。在不良反应、住院时间及出院3个月内急性加重次数上3组无差异(P>0.05)。结论每天及每次雾化吸入高剂量布地奈德可在更快更明显改善FEV1%、小气道功能及症状,提高患者依从性。

Objective To study the efficacy and safety of different doses of Nebulized Budesonide(NB)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A total of 321 patients with moderate and severe AECOPD were randomly divided into 3 groups:Group A was given 4 mg of NB a day(1 mg q6 h,95 cases),group B was given 8 mg of NB a day(2 mg q6 h,111 cases)and group C was also given 8 mg of NB a day(4 mg q12 h,115 cases),and all the groups were treated with routine therapy,including oxygen,expectoration,nebulized short-effect bronchodilators,antibiotics,etc. The CAT score,pulmonary function,and blood gas analysis were measured before treatment,3 hours and 5 days after nebulization. The adverse effect,hospital stay,the frequency of acute exacerbations within 3 months after discharge and the adverse events during treatment were compared. Results Compared with before,the changes in FEV1% were statistically significant at 3 hours in Group C(P < 0.05). Compared with Group A,the differences in FEV1% at 3 hours and MEF50%、MEF25% ~ 75%、CAT score at 5 days were statistically significant in Group C(P < 0.05). In addition,the improvements in FEV1%were statistically significant at 5 days between 3 groups(P < 0.05). There were no differences in adverse effects,hospital stay and frequency of exacerbations within 3 months after discharge between groups. Conclusion Nebulized budesonide with higher doses a day and each one treatment improves pulmonary function and symptoms better in the treatment of AECOPD,and the compliance of patients is improved,the manpower and material resources are reduced.