雾化吸入激素治疗老年人支气管哮喘急性发作期的对照试验研究

目的：通过对哮喘急性加重期应用不同方式、不同剂量糖皮质激素的观察研究,探讨一种更理想的治疗哮喘急性加重期的方法。方法：将符合哮喘诊断的83例哮喘急性加重期的患者进行区组随机化分组研究,将实验对象分为4组,分别为A组布地奈德（budesonide,BUD）2000μg组18例,定量雾化吸入BUD500μg/次,每30分钟1次,总吸入剂量为2000μg/d;B组BUD4000μg组21例,定量雾化吸入BUD1000μg/次,每30分钟1次,总吸入剂量为4000μg/d;C组BUD6000μg组22例,定量雾化吸入BUD1500μg/次,每30分钟1次,总吸入剂量为6000μg/d;D组泼尼松（prednisone,PRED）组22例,泼尼松30mg/d,顿服。在试验开始、结束及过程中完成急性哮喘临床指标评分、肺通气功能、肾上腺皮质功能测定。结果：在4组哮喘急性加重期患者中,口服泼尼松（prednisone,PRED）及雾化吸入糖皮质激素组在治疗后急性哮喘临床指标评分均较治疗前有改善,差异有统计学意义（P〈0.05）。反应大气道功能的指标FEV1、PEF均较治疗前提高,差异有统计学意义（P〈0.05）。治疗4h和第2天时各组间临床评分和肺功能改善的差值差异无统计学意义,第7天开始各组间临床评分和肺功能改善的差值,差异无统计学意义;肺功能改善的差值呈布地奈德（budesonide,BUD）6000μg组（C组）〉布地奈德4000μg组（B组）〉布地奈德2000μg组（A组）,在C组及PRED组（D组）间差异无统计学意义。24h尿皮质醇检测,吸入糖皮质激素和口服用糖皮质激素组治疗后均逐渐降低,但差异无统计学意义。结论：应用糖皮质激素是一种治疗支气管哮喘急性发作期的有效方法,当比较治疗效果及副作用时,雾化吸入糖皮质激素是一种较为理想的治疗支气管哮喘急性发作期的方法。

The effect of inhaled corticosteroids in the treatment of acute exacerbations of bronchial asthma in older adult

Objective： To investigate the best method of treatment of acute exacerbation of bronchial asthma within different ways, different does of corticosteroids. Methods： 83 patients diagnosed as acute exacerbation of bronchial asthma were divided into 4 groups in the randomized block method. There were 18 patients in the A group of BUD 2 000 μg, quantitative budesonide inhalation 500 μg once, every 30 minutes, the total inhaled dose was 2 000 μg/d; 21 patients in the B group of BUD 4 000 μg, quantitative budesonide inhalation 1 000 μg once, every 30 minutes, the total inhaled dose was 4 000 μg/d; 22 patients in the C group of BUD 6 000 μg, quantitative budesonide inhalation 1 500 μg once, every 30 minutes, the total inhaled dose was 6 000 μg/d; 22 patients in the D group of prednisone, 30 mg/d, took at a draught. Pulmonary function test, clinic assessment score and adrenocortex function test were completed at the beginning, the end and the course of the trial. Results： Within the 4 groups of patients with acute exacerbation of bronchial asthma, clinical assessment scores were declined after the treatment, with statistical differences （P〈0.05）. The value of FEV1 and PEF which reflected the function of tracts improved with statistical differences （P〈0.05）. There were similar improvements in clinical assessment score and lung function in the four groups at the time of 4 hours and the second day after treatment; 7 days after the beginning of treatment similar improvements in clinical assessment score and lung function in the four groups, and the difference of the improvements in lung function between the group of BUD 6 000 μg and PRED was not significant, but these lung function parameters were well improved in the group of BUD 6 000 μg （C） 〉BUD 4 000 μg （B） 〉 BUD 2 000 μg （A）. The urocortisol test in 24 hours which reflected the adrenocortex function were declined in the four groups, with no significant difference. Conclusion： Using ICS is an effective method in the treatment of acute exacerbations of bronchial asthma undoubtedly. When concerning the efficacy and side effects, inhaled corticosteroids is an ideal method in the treatment of acute exacerbations of bronchial asthma.