摘要
目的 评价新型插管内雾化布地奈德对慢性阻塞性肺病急性加重（AECOPD）机械通气患者替代全身性激素的治疗作用.方法 90例入选AECOPD机械通气患者在抗感染、应用支气管扩张药物、稳定内环境、营养支持等基础上随机分为三组,即口插管内雾化吸入布地奈德 2 mg 12 h一次组（A组）、口插管内雾化吸入布地奈德1 mg 12 h一次组（B组）、静脉滴注地塞米松2.5 mg 12 h一次组（C组）,治疗初始、治疗1 d、治疗3 d、治疗5 d及脱机前检测静态气道阻力、PEEPi、FVC％Pred、P0.1、MIP,分析三组机械通气时间、呼吸机相关性肺炎（VAP）发生率、痰真菌培养阳性率、1个月内再插管率、空腹血糖水平. 结果 三组治疗3 d、5 d静态气道阻力、PEEPi均有下降,下降幅度为A组〉B组〉C组（ P 〈0.05）;三组治疗3 d、5 d FVC%Pred均有升高,升高幅度为A组〉B组〉C组（ P 〈0.05）;三组治疗5 d P0.1、MIP比较差异有统计学意义（ P 〈0.05）;三组机械通气时间为A组〈B组〈C组（ P 〈0.01）;三组VAP发生率、痰真菌培养阳性率比较差异均无统计学意义.布地奈德组1个月内再插管率和空腹血糖水平均显著低于静脉糖皮质激素组（ P 〈0.05）,而不同剂量布地奈德组间比较差异无统计学意义. 结论 新型插管内雾化布地奈德在AECOPD机械通气患者中可替代全身性激素治疗,而且大剂量布地奈德雾化疗效优于小剂量.
Objective To evaluate the curative effect of nebulized budesonide （NB） instead of systemic eorticosteroids （SC） in the treatment of patients with acute exacerbations of chronic obstructive puhnonary disease （AECOPD） . Methods Patients with AECOPD （ n = 90） were divided into randomly three groups： group A received NB （ 2 mg q 12 h）, group B received NB （1 mg q 12h）, and group C received dexamethasone （2.5 mg q 12 h）. The indices of static lung compliance, PEEPi, FVC% Pred, PO. 1, MIP, duration of mechanical ventilation, incidence rate of ventilator - associated pneumonia （VAP） , the positive rate of sputum fungal culture, the rate of reintubation within one month, and fasting blood glucose were statistically analyzed. Results Static lung compliance, PEEPi, and FVC% Pred were all decreased in three groups at the 3rd and 5th day, while the decreased degree in the three groups was group A 〉 group B 〉 group C （ P 〈 0.05 ）. There were significant differences in P0.1, MIP at the 5th day among three groups （ P 〈 0.05 ）. The duration of mechanical ventilation in three groups were group A 〈 group B 〈 group C（P 〈 0.01 ）. Incidence rate of VAP, the positive rate of sputum fungal culture had no significant differences in the three groups. The rate of reintubation within one month, and fasting blood glucose were significantly lower in NB groups than those in SC group （ P 〈 0. 05 ） ; while there were no significant differences between the different doses groups of budesonide. Conclusion The study demonstrates that nebulized budesonide may be an effective and safe alternative instead of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease The large dose of nebulised budesonide was better than small dose.
出处
《中国急救医学》
CAS
CSCD
北大核心
2011年第1期21-25,共5页
Chinese Journal of Critical Care Medicine
基金
绍兴市重点科技计划项目（2008A23005）作者单位
关键词
雾化布地奈德
慢性阻塞性肺病急性加重
机械通气
Nebulized budesonide
Acute exacerbation of chronic obstructive pulmonary disease（AECOPD） ： Meehanieal ventilation
