抗生素降阶梯治疗方案结合肺康复训练对老年COPD患者呼吸功能及生存质量的影响

Effects of antibiotic de-escalation therapy combined with pulmonary rehabilitation training on respiratory function and quality of life in elderly patients with chronic obstructive pulmonary disease

目的探讨抗生素降阶梯治疗方案结合肺康复训练对老年COPD患者呼吸功能及生存质量的影响。方法选择2020年9月至2021年8月收治的老年COPD患者96例,按治疗方案不同分为对照组和观察组,每组48例。对照组给予常规治疗,观察组采用抗生素降阶梯治疗方案结合肺康复训练。比较治疗前后2组血清炎性因子及外周血白细胞CD64呼吸功能和血气指标变化情况;随访3个月,比较2组生活质量情况。结果治疗后,2组血清TNF-α、CRP、LTB4及CD64指数明显降低(P<0.05),观察组比对照组更明显(P<0.05);治疗后,2组血气指标及呼吸衰竭指数水平明显改善(P<0.05),且观察组更明显(P<0.05);治疗后,观察组呼吸功能指标较对照组改善更明显(P<0.05);治疗后3个月,观察组生活质量水平明显优于对照组(P<0.05)。结论对老年COPD患者采取抗生素降阶梯治疗方案结合肺康复训练治疗,可减轻炎性反应,改善呼吸功能,提高其生活质量,具有一定的临床应用价值。

Objective To investigate the effect of antibiotic de-escalation therapy combined with pulmonary rehabilitation training on respiratory function and quality of life of elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 96 elderly COPD patients admitted in our hospital from September 2020 to August 2021 were selected and randomly divided into the control group(48 cases)and the observation group(48 cases)according to different treatment schemes.Patients in the control group were given routine treatment,and those in the observation group were given antibiotic de-escalation therapy combined with pulmonary rehabilitation training.The changes in serum inflammatory factors and peripheral blood leukocyte CD64 in the two groups were compared before and after treatment.The respiratory function and blood gas indexes of the two groups were compared before and after treatment.Patients were followed up for 3 months,and the quality of life of the two groups was compared.Results After treatment,serum tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),leukotriene B4(LTB4)and CD64 decreased significantly in both groups,which were significantly lower in the observation group than those of the control group(P<0.05).After treatment,blood gas indexes and respiratory failure indexes in both groups were significantly improved,especially in the observation group(P<0.05).After treatment,the respiratory function indexes in the observation group improved more significantly than those of the control group(P<0.05).Three months after treatment,the quality of life in the observation group was significantly better than that of the control group(P<0.05).Conclusion Antibiotic de-escalation therapy combined with pulmonary rehabilitation training for elderly COPD patients can reduce inflammatory response,and improve respiratory function and the quality of life,which has certain clinical application value.