布地奈德雾化吸入对慢性阻塞性肺疾病患者呼吸机相关性肺炎的影响

目的探讨雾化吸入布地奈德对慢性阻塞性肺疾病（COPD）合并呼吸机相关性肺炎（VAP）的影响。方法49例COPD合并VAP患者,随机分成两组：对照组24例,应用复方异丙托溴铵雾化吸入合用广谱抗菌素;观察组25例,在对照组治疗基础上雾化器中加入布地奈德混悬液,与复方异丙托溴铵同时雾化。观察两组患者的疗效和上机72h后支气管肺泡灌洗液（BALF）中肿瘤坏死因α（TNF-α）、白细胞介素8（IL-8）的变化。结果观察组患者上机72h后BALF中TNF—α和IL-8水平较对照组均明显降低（均P〈0．05）。观察组患者症状和体征,以及床旁胸片改善时间、脱机时间、拔管时间、出院时间均优于对照组（均P〈0．05）。观察组临床治愈率未改善。结论雾化吸入糖皮质激素可减轻气道炎性反应,可缩短COPD合并VAP患者的上机时间,改善预后。

Effect of budesonide nebulization in treatment of patients with chronic obstructive pulmonary disease and ventilator-associated pneumonia

Objective To explore the effect of budesonide nebulization in treatment of patients with chronic obstructive pulmonary disease and ventilator-associated pneumonia. Methods A total of 49 cases with COPD and VAP was randomly divided into two groups:the control group consisted of 24 patients received salbutamol nebulization on the routine treatment.The observe group consisted of 25 patients received budesonide plus salbutamol bulization on the routine treatment.Variables such as TNF-αt and IL-8 in the bronchial alveolar lavage fluid(BALF),and efficacy of pneumonia and clinical healing rate were observed. Results The levels of TNF-α and IL-8 in BALF of the observe group were significantly lower than those in the control group after 72h(all P＜0.05).The days of symptoms,signs and bedside chest X-ray improved,off-machine time,extubation time and the days of inpatient were statistically shorter in observe group compared with the control group(all P＜0.05).But the clinical cure rate of the observe group was no significant improvement. Conclusion The nebulization of budesonide could suppress the local pulmonary inflammation and reduce the time of machine ventilation and improve prognosis in COPD patients with VAP.