老年普通型新型冠状病毒肺炎治疗中短期小剂量糖皮质激素应用观察

Clinical observation of short-term and low-dose glucocorticosteroid in treatment of moderate COVID-19 in elderly patients

目的观察老年普通型新型冠状病毒肺炎治疗中短期小剂量应用糖皮质激素的效果。方法120例老年普通型新型冠状病毒肺炎患者根据是否使用激素治疗分为两组,实验组在常规治疗基础上给予糖皮质激素(若患者体温≥38℃,给予甲泼尼龙琥珀酸钠40 mg/次,2次/d;若体温<38℃,给予甲泼尼龙琥珀酸钠40 mg/次,1次/d,一般2~3 d减半,持续5~7 d),对照组仅给予常规治疗。比较实验组和对照组肺部CT好转率及好转所需时间,发热持续时间及发热、咳嗽、乏力的消失率,住院期间患者出现病情加重比例,并发症(继发感染、继发糖尿病、低钙血症)发生率。结果实验组、对照组肺部CT好转率分别为86.7%、71.7%,两组比较,P<0.05;实验组、对照组肺部CT好转所需时间分别为(8.56±2.88)、(13.9±4.07)d,两组比较,P<0.05。实验组、对照组发热持续时间分别为(6.25±3.77)、(14.45±7.67)d,两组比较,P<0.05;实验组、对照组发热及咳嗽消失分别为41(83.7%)、23(47.9%),31(59.6%)、10例(21.3%),两组比较,P<0.05;两组乏力消失率比较,P>0.05。实验组、对照组病情加重分别为5(8.3%)、17例(28.3%),两组比较,P<0.05。实验组出现继发感染、继发糖尿病、低钙血症分别为8、4、2例,对照组分别为6、0、0例,两组比较,P均>0.05。结论老年普通型新型冠状病毒肺炎治疗中短期小剂量应用糖皮质激素能够更快地促进肺部病灶吸收,改善临床症状,控制病情进展。

Objective To observe the therapeutic effect of short-term and low-dose glucocorticosteroid in treatment of the elderly patients with moderate coronavirus disease 2019(COVID-19).Methods Totally 120 elderly patients with moderate COVID-19 were divided into the experimental group(basic treatment combined with glucocorticosteroid)and the control group(basic treatment).The disappearance rate of cardinal symptoms(fever,cough and weakness),the proportion of patients with aggravation,pulmonary CT improvement rate,the incidence of glucocorticosteroid complications(secondary infection,secondary diabetes,and hypocalcemia)during hospitalization were compared between these two groups.Results The improvement rates of pulmonary CT in the experimental group and the control group were 86.7%and 71.7%,respectively(P>0.05).The time needed for the improvement of pulmonary CT in the experimental group and the control group was(8.56±2.88)d and(13.9±4.07)d,respectively(P<0.05).The duration of fever in the experimental group and control group was(6.25±3.77)d and(14.45±7.67)d,respectively(P<0.05).The disappearance rates of fever and cough in the experimental group were 83.7%and 47.9%versus 59.6%and 21.3%in the control group(both P<0.05).Five(8.3%)and 17 cases(28.3%)were aggravated in the experimental group and the control group,respectively(P<0.05).The incidence of secondary infection,hyperglycemia and hypocalcemia in the experimental group was 13.3%,6.7%and 3.3%,respectively,versus 10%,0 and 0,respectively,in the control group(all P>0.05).Conclusion Short-term and low-dose glucocorticosteroid in treatment of moderate COVID-19 elderly patients can make a faster absorption of lung focus,improve clinical symptoms and significantly control the exacerbation of patients during hospitalization.