老年哮喘急性发作期糖皮质激素治疗剂量的合理选择

Rational Choice of Glucocorticoid Treatment Dose in Elderly Patients with Acute Asthma

目的分析老年哮喘急性发作期糖皮质激素的合理治疗剂量。方法将2016年1月—2019年1月收治的180例老年哮喘急性发作期患者编入A组、B组与C组,分别给予不同剂量的糖皮质激素治疗,分析3组患者的治疗总有效率、临床症状评分、症状消失时间、肺功能指标及不良反应发生率。结果B组的治疗总有效率为96.7%,A组、C组的治疗总有效率低于B组,组间差异有统计学意义(A、B组组间χ2=6.988,P=0.008<0.05,B、C组组间χ2=4.904,P=0.027<0.05)。B组的不良反应发生率为3.3%,低于A组与C组,组间差异有统计学意义(A、B组组间χ2=5.926,P=0.015<0.05,B、C组组间(χ2=4.904,P=0.027<0.05)。A组、B组与C组的FEV1指标分别为(2.7±0.4)L、(2.8±0.6)L与(2.9±0.7)L,差异无统计学意义(A、B组组间t=1.074,P=0.285>0.05,B、C组组间t=0.840,P=0.403>0.05),FEV1/FVC分别为(41.5±9.3)%、(42.8±10.4)%与(43.2±11.8)%,差异无统计学意义(A、B组组间t=0.722,P=0.472>0.05,B、C组组间t=0.197,P=0.844>0.05)。A、B、C组的临床症状评分分别为(1.4±0.7)分、(1.5±0.8)分与(1.6±0.9)分,差异无统计学意义(A、B组组间t=0.729,P=0.468>0.05,B、C组组间t=0.643,P=0.521>0.05)。B组症状消失时间为(5.1±0.2)min,低于A组与C组,差异有统计学意义(A、B组组间t=25.205,P=0.000<0.05,B、C组组间t=23.632,P=0.000<0.05)。结论不同剂量的糖皮质激素治疗方案在老年哮喘急性发作期治疗中均具有一定的临床效果。400μg/d布地奈德吸入治疗的治疗效果更为理想,不良反应发生率相对较低,更具有安全性与有效性。

Objective To analyze the reasonable therapeutic dose of glucocorticoids in elderly patients with acute asthma.Methods 180 elderly patients with acute asthma who were treated from January 2016 to January 2019 were assigned to group A,group B and group C,and were treated with different doses of glucocorticoids.The total treatment of the three groups of patients was analyzed.Effectiveness,clinical symptom score,time to disappear symptoms,pulmonary function index and incidence of adverse reactions were analyzed.Results The total effective rate of treatment in group B was 96.7%,and the total effective rate of treatment in groups A and C was lower than that in group B.The difference between the groups was statistically significant(χ2=6.988,P=0.008<0.05 between groups A and B,χ2=4.904,P=0.027<0.05 between groups B and C).The incidence of adverse reactions in group B was 3.3%,which was lower than that in groups A and C.The difference between the groups was significant(χ2=5.926,P=0.015<0.05 between groups A and B,and(χ2=4.904,P=0.027<0.05)between groups B and C).The FEV1 of group A,group B and group C were(2.7±0.4)L,(2.8±0.6)L and(2.9±0.7)L,respectively,The difference was not statistically significant(t=1.074,P=0.285>0.05 between groups A and B;t=0.840,P=0.403>0.05 between groups B and C),FEV1/FVCwere(41.5±9.3)%,(42.8±10.4)%,and(43.2±11.8)%,respectively,The difference was not statistically significant(t=0.722,P=0.472>0.05 between groups A and B,t=0.197,P=0.844>0.05 between groups B and C).The clinical symptom scores of group A、B、C、were(1.4±0.7)points,(1.5±0.8)points and(1.6±0.9)points,and The difference was not statistically significant(t=0.729,P=0.468>0.05 between groups A and B,t=0.643,P=0.521>0.05 between groups B and C),the time for the disappearance of symptoms was(5.1±0.2)min,which was lower than that of groups A and C,and the difference was statistically significant(t=25.205,P=0.000<0.05 between groups A and B,t=23.632,P=0.000<0.05 between groups B and C).Conclusion Different doses of glucocorticoid treatment schemes have certain clinical effects in the treatment of acute asthma in elderly patients.The treatment effect of 400μg/d budesonide inhalation therapy is more ideal,the incidence of adverse reactions is relatively low,and it is more safe and effective.