糖皮质激素治疗慢性阻塞性肺疾病急性加重期的效果观察

目的比较雾化吸入与静脉使用糖皮质激素在治疗慢性阻塞性肺疾病急性加重期（AECOPD）患者的疗效。方法回顾分析133例AECOPD患者，分为常规治疗组（A组）、甲泼尼龙组（B组）、布地奈德雾化组（c组），其中B组予甲泼尼龙针静脉推注，40mg·d-1，1次·d-1；C组予布地奈德混悬液雾化吸入，2mg·次-1，3次·d-1，观察3组患者治疗前后肺功能、动脉血气分析、呼吸困难评分的变化。结果治疗后7d，A组、B组、c组第一秒用力呼气容积（FEV1.0）分别是（52．35±4．25）％、（63．21±4．08）％、（62．44±5．43）％；动脉氧分压（PaO2）分别是（61.14±5．20）mmHg、（69．90±5．69）mmHg、（67．62±8．65）mmHg，二氧化碳分压（PaCO2）分别为（52．79±4．05）mmHg、（45．71±4．26）mmHg、（46．98±5．17）mmHg；呼吸困难评分分别为（2．58±0．47）分、（1．84±0．53）分、（1．89±0．42）分。治疗后3组患者FEV1.0、PaO2、PaCO2及呼吸困难评分差异有统计学意义（P〈0．05），甲泼尼龙组与布地奈德组差异无统计学意义（P〉0．05）。结论在AECOPD治疗中，雾化吸入布地奈德6mg·d-1与静脉使用甲泼尼松龙40mg·d-1有相同的临床疗效。

Effects of corticosteroids in the treatment of patients with acute exacerbations of chronic obstructive pulmonary disease

Objective To compare clinical effect of intravenous corticosteroids and inhaled corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease （AECOPD）. Methods 133 patients were randomly divided into three groups. Group A was given normal treatment; group B received 40mg of methylpredisolone once a day plus normal treatment ; group C was given 2mg of budesoninde three times a day plus normal treatment. The changes of pulmonary function, blood gas and decompensation before and after the treatment were observed. Results 7 days after treatment, FEVI o in patients with group A,group B,and group C were （52.35 ± 4.25 ） %, （63.21 ± 4.08 ） % and（62.44 ±5.43 ） %, and PaO2 of three groups were （ 61.14 ± 5.20） mmHg, （69.90 ± 5.69 ） mmHg, （67.62 ＋ 8.65 ） mmHg, and PaCO2 of three groups were （ 52.79 ± 4.05 ） mmHg, （45.71 ±4.26） mmHg, （46.98 ± 5.17 ） mm Hg,and the level of side - effects decompensation of three groups were respectively 2.58 ± 0.47,1.84 ± 0.53 and 1.89 ± 0. 42. There were significant differences on FEV1.0 ,PaO2, PaCO2 and decompensation between three groups after treatment （P 〈 0.05 ）. There was no significant difference between group B and group C （P 〉 0. 05）. Conclusion Budesoninde 6mg/day can treat patients with AECOPD as methylpredisolone 40 mg.day-1 do.