足量雾化布地奈德循证治疗慢性阻塞性肺疾病急性加重期1例

目的了解足量雾化吸入布地奈德用于慢性阻塞性肺疾病（COPD）急性加重期治疗的有效性及安全性,为1例COPD急性加重期患者制定治疗方案。方法计算机检索Cochrane图书馆（2009年第4期）、MEDLINE（1990～2010.2）、ACP Journal Club（1991～2010.2）及中国期刊全文数据库（1979～2010.2）,查找足量雾化吸入布地奈德治疗COPD急性加重期的系统评价、临床随机对照试验,并对所获证据进行质量评价,进而应用于本例患者的临床治疗。结果共纳入4篇临床随机对照试验,研究质量较高。现有证据表明足量雾化吸入布地奈德可减轻COPD急性加重期患者的临床症状,改善肺功能,且无严重不良反应。我们将上述证据应用于临床,对1例COPD急性加重期患者行足量雾化吸入布地奈德治疗,该患者症状控制良好,未发生不良反应。结论足量雾化吸入布地奈德安全有效,可替代全身激素而应用于COPD急性加重期的治疗。

Evidence-Based Treatment of a Patient with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Nebulized Budesonide

Objective To investigate the efficacy and safety of nebulized budesonide for acute exacerbation of chronic obstructive pulmonary disease,and to formulate an evidence-based treatment protocol for a patient with acute exacerbation of chronic obstructive pulmonary disease.Methods We searched The Cochrane Library（Issue 4,2009）,MEDLINE（1990 to February 2010）,ACP Journal Club（1991 to February 2010） and Chinese Journal Full-text Database（1979 to February 2010）,and critically appraised the available evidence.Results Four randomized controlled trials were included,and all were of relatively high quality.Evidence showed that nebulized budesonide could alleviate symptoms,improve pulmonary function without any serious side effects.Given the current evidence,we used nebulized budesonide which helped the control of symptoms with no adverse effects.Conclusion Nebulised budesonide may be an effective and safe alternative to systemic corticosteroids in the treatment of acute exacerbation of chronic obstructive pulmonary disease.