两种呼吸喹诺酮类抗菌药序贯给药治疗老年重症慢性阻塞性肺疾病急性加重的对比研究

Sequential administration of two fluoroquinolones in the treatment of elderly patients with acute exacerbation of severe chronic obstructive pulmonary disease

目的比较2种呼吸喹诺酮类抗菌药(莫西沙星与左氧氟沙星)序贯给药治疗老年重症慢性阻塞性肺疾病急性加重(AECOPD)的有效性及安全性。方法选择我院2017年1月至2019年10月收治的老年重症AECOPD病人120例,采用随机数字表法分成观察组(n=60)和对照组(n=60)。其中观察组采取莫西沙星序贯给药治疗,对照组采用左氧氟沙星序贯给药治疗。比较2组细菌清除率、不良反应以及治疗前后肺功能参数与血气指标。结果观察组总有效率[91.67%(55/60)]与对照组[73.33%(44/60)]相比显著升高(P<0.05)。观察组病原菌清除率为81.58%(31/38),与对照组[60.00%(21/35)]相比,显著增高(P<0.05)。2组治疗后FEV1、FVC及FEV1/FVC均较治疗前显著升高(P<0.05),且观察组升高更明显(P<0.05)。2组治疗后PaO2、动脉血氧饱和度(SaO2)均较治疗前显著上升(P<0.05),PaCO2显著下降(P<0.05),且观察组变化更明显(P<0.05)。2组不良反应发生率比较(8.33%比10.00%),差异无统计学意义(P>0.05)。结论应用莫西沙星序贯疗法治疗老年重症AECOPD,相对于左氧氟沙星序贯给药治疗能进一步改善病人的肺功能,改善缺氧和二氧化碳潴留情况,病原菌清除率更高,整体疗效更为确切,且两者安全性相当。

Objective To compare the efficacy and safety of Moxifloxacin and Levofloxacin by sequential administration in the treatment of acute exacerbation of severe chronic obstructive pulmonary disease(AECOPD)in the elderly.Methods A total of 120 elderly patients with severe AECOPD admitted from January 2017 to October 2019 were randomly divided into observation group and control group with 60 cases in each group.In the observation group,Moxifloxacin was given sequentially,while in the control group,Levofloxacin was given sequentially.All subjects were treated continuously for 10 days.The bacteria clearance and the occurrence of side reaction were counted.Before and after treatment,the parameters of lung function,such as forced breath volume in the first second(FEV1),forced vital capacity(FVC),FEV1/FVC,arterial oxygen and carbon dioxide partial pressure(PaO2 and PaCO2)and arterial oxygenation were measured and compared.Results After treatment,the total effective rate of the observation group was 91.67%(55/60),which was significantly higher than that of the control group(73.33%).In the observation group,38 strains were isolated and 31 strains were eliminated,and the pathogen clearance rate was 81.58%(31/38),compared with 60.00%(21/35)in the control group.After treatment,FEV1,FVC and FEV1/FVC in the two groups were significantly higher than those before treatment,especially in the observation group(P<0.05).The levels of PaO2 and SaO2 were significantly increased,and the level of PaCO2 was significantly decreased in both groups after treatment,and especially in the observation group(P<0.05).There was no significant difference in the adverse reaction rate between the two groups(8.33%vs 10.00%,P>0.05).Conclusions The sequential therapy of moxexine in the treatment of severe AECOPD in the elderly can improve the pulmonary function,hypoxia and carbon dioxide retention,and the clearance rate of pathogenic bacteria is more significantly than the sequential therapy of Levofloxacin.