雾化吸入大剂量布地奈德治疗重度慢性阻塞性肺疾病急性发作的临床分析

目的：观察雾化吸入大剂量（6mg／d）普米克令舒（布地奈德混悬液）治疗重度慢性阻塞性肺疾病急性发作（AECOPD）的临床疗效。方法：60例重度AECOPD住院患者随机分为两组：治疗组30例给予普米克令舒2mgq8h氧气驱动雾化吸入15min；阳性对照组，30例给予地塞米松10mg／d静脉滴注，两组患者均给予可必特（沙丁胺醇＋异丙托溴胺）混悬液联合雾化吸入2mLq8h以及静脉滴注抗生索与吸氧、化痰或呼吸兴奋剂等治疗，记录两组患者用药前后临床症状体征以及PaO2、PaCO2、FEV1的变化，同时观察不良反应及疗效分析。结果：两组患者治疗前后临床表现与PaO2、PaCO2、FEV1均有改善，治疗前后相比差异有统计学意义（P〈0．05）；两组间总有效率相比（治疗组90％、对照组93．3％）差异无统计学意义（P〉0．05）；但治疗组不良反应明显少于对照组。结论：雾化吸入普米克令舒能够改善重度AECOPD患者肺功能及临床症状，与全身使用地塞米松疗效相近，但不良反应，安全性较好。

Large-dose Nebulized Pulmicort Respules in the treatment of patients with severe AECOPD

Objective： To evaluate the efficacy of Nebulized Pulmicort Respules （Budesonide） in the treatment of severe acute exacerbations of chronic obstructive pulmonary disease （AECOPD）. Methods ： 60 hospitalized patients with AECOPD were randomized into 2 groups： 30 in the treatment group to receive oxygen- driven nebulized Pulmicort Respules （2 mg） for 15 min every 8 h, and 30 in the control group to receive intravenous use of 10mg/d dexamethasone. The both groups were also treated with nebulized suspension of Combivent （salbutamol and ipratropium bromide ）, intravenous antibiotics, oxygen therapy, expectorants and respiratory stimulants. Clinical symptoms and signs were observed, as well as PaO2, PaCOz and FEV1 measured in the patients pre-treatment and post-treatment. The adverse reactions and treatment efficacy were evaluated at the same time. Results： Both groups experienced statistically significant improvements in clinical manifestations, PaO2, PaCO2 and FEV1 after treatment, as compared with baseline （P 〈 0. 05 ）. The overall rate of response was comparable between the groups（90% in the Pulmicort Respule treated group vs 93.3% in the controls, P 〉 0. 05）. However,patients on Pulmicort Respules reported less adverse reactions than those on dexamethasone. Conclusion：Nebulized Pulmicort Respules provides similar efficacy but less adverse reactions compared with systematic dexamethasone in improving pulmonary function and clinical manifestation in AECOPD patients.