口服及雾化吸入糖皮质激素治疗老年慢性阻塞性肺疾病急性加重的研究

目的观察口服及雾化吸入糖皮质激素对老年慢性阻塞性肺疾病急性加重（AECOPD）的疗效、安全性。方法将70例老年中重度AECOPD患者随机分为3组,雾化吸入布地奈德组：布地奈德混悬液2mg/次雾化吸入,2次/d,连续7d;口服泼尼松组：泼尼松30mg/d,连续7d;对照组：不使用任何糖皮质激素。3组其他常规治疗相同,比较3组治疗前后及治疗后3组间肺功能FEV1、血气分析、圣.乔治生活质量评分（SGRQ）和不良反应。结果和对照组比较,雾化吸入组、口服激素组的FEV1、PaO2、PaCO2、SGRQ评分改善值差异有统计学意义（P〈0.05）;雾化吸入、口服激素两组各项指标改善程度相似（P〉0.05）;但雾化吸入组不良反应明显低于口服强的松组（P〈0.05）。结论雾化吸入布地奈德混悬液疗效与口服激素相似,可减轻临床症状,有效改善气流受限;雾化吸入激素全身不良反应小,可作为激素治疗的另一种选择。

Oral prednisone and inhaled glucocorticoid in the treatment of acute exacerbations of chronic obstructive pulmonary disease in elderly patients

Objective To observe the effects and safety of inhaling and oral glucocorticoid in the treatment of acute exacerbations of chronic obstructive pulmonary disease in elderly patients.Methods Seventy elderly hospital patients with moderate to severe AECOPD were randomly divided into three groups.The nebulized budesonide（NB） group：Received nebulized budesonide by exacerbation with 2mg every 12h.The oral prednisone group was treated with 30mg every day.The control group was offered common treatment and not treated with adrenocortical hormones.All groups were observed for 7d.The change of symptom,FEV1,PaO2,PaCO2 and adverse effects were measured.Results Both NB and oral prednisone group improved in FEV1,PaO2,PaCO2 and SGRQ when compared with placebo（P0.05）.The difference in FEV1,PaO2,PaCO2 between NB and oral prednisone group was not significant（P0.05）.The occurrence of serious adverse effects in the NS group were lower than the oral prednisone group（P0.05）.Conclusion Both budesonide and oral prednisone can improved the symptom and obstruent airflow in COPD patients.Nebulized budesonide may be an alternative to oral prednisone in the treatment of acute exacerbations of COPD with lower adverse events.