雾化吸入N-乙酰半胱氨酸在老年慢性阻塞性肺疾病急性加重患者治疗中的应用

目的：探讨雾化吸入N-乙酰半胱氨酸（NAC）治疗老年慢性阻塞性肺疾病急性加重（AECOPD）患者的临床效果，阐明雾化吸入NAC作为AECOPD患者常规治疗的应用价值。方法：选择78例老年AECOPD患者作为研究对象，随机分为对照组38例和NAC组40例。2组患者均给予常规治疗，NAC组患者加用雾化吸入NAC，每次0.3 g，每日2次，对照组患者给予生理盐水。记录治疗前后患者动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、第1秒用力呼气容积（FEV1）、FEV1占预计值百分比（FEV1% pred）、临床慢性阻塞性肺疾病（COPD）问卷调查（CCQ）评分、静脉皮质醇激素使用率、院内感染发生率和住院时间，并进行统计学分析。结果：与对照组比较，NAC组患者PaO₂改善值明显升高（P=0.033），而PaCO₂和肺功能（FEV1和FEV1% pred）改善值差异无统计学意义（P>0.05）；NAC组CCQ评分低于对照组，其改善值比较差异有统计学意义（P<0.05）；NAC组和对照组患者静脉皮质醇激素使用率、院内感染发生率和住院天数比较差异无统计学意义（P>0.05）。结论：常规雾化吸入NAC能明显改善老年AECOPD患者PaO₂和临床症状，但对肺功能、静脉皮质醇激素使用率、院内感染发生率和住院天数无明显影响。

Application of N-acetylcysteine inhalation in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease

Objective:To explore the curative effect of N-acetylcysteine (NAC)inhalation in the treatment of the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to clarify the application value of NAC in the regular treatment of the AECOPD patients. Methods:A total of 78 elderly patients with AECOPD were enrolled and randomly divided into control group(n=38) and NAC group(n=40). The patients in two groups all received regular treatment; the patients in NAC group received additional NAC inhalation (0.3 g, 2 times per day) while the patients in control group received normal saline inhalation. The arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), forced expiratory volume in 1 second(FEV1), forced expiratory volume in FEV1% predicted(FEV1%pred), the clinical COPD Questionnaire(CCQ) score, as well as the rates of intravenous steroid infusion, the incidence of hospital infection and the duration of hospitalization before and after treatment were recorded. Results:Compared with control group, the difference values of PaO₂ of the patients in NAC group was significantly increased(P=0.033),but there were no significant differences in the difference values of PaO₂,FEV1 and FEV1% pred(P>0.05);the CCQ score of the patients in NAC group was significantly higher than that in control group,and there was significant difference in the difference values(P<0.05).There were no significant differences in the rates of intravenous steroid infusion,the incidence of hospital infection and the duration of hospitalization of the patients between two groups(P>0.05). Conclusion:NAC inhalation could apparently improve the PaO₂ and the clinical symptoms in the elderly AECOPD patients, but has no significant effects on the pulmonary function, the rate of intravenous steroid infusion,the incidence of hospital infection and the duration of hospitalization.