摘要
目的探讨糖皮质激素不同给药方式对慢性阻塞性肺疾病急性加重期(AECOPD)患者炎症因子及肺功能的影响。方法 94例AECOPD患者随机分为静脉组(32例)、口服组(32例)和雾化吸入组(30例)。均在抗感染、平喘、化痰及维持酸碱平衡等常规对症治疗的基础上,静脉组:甲泼尼龙1 mg·kg^(-1)·d^(-1),第1~3d,0.5 mg·kg^(-1)·d^(-1),第4~7d;口服组:泼尼松30~40mg/d,第1~7d;雾化吸入组:布地奈德4mg/d,2次/d,第1~7d。比较各组患者血清炎症因子、肺功能变化,以及不良反应发生情况。结果治疗后,各组血清各炎症因子均明显降低(P<0.05),而各组间治疗后各炎症因子无显著性差异(P>0.05);治疗后,各组肺功能指标均有不同程度改善,静脉组FEV_1%、FEV_1/FVC显著优于雾化吸入组(P<0.05),而各肺功能指标在静脉组与口服组,口服组与雾化吸入组间无显著性差异(P>0.05);雾化吸入组的不良反应发生率显著低于静脉组、口服组(P<0.05),而静脉组、口服组不良反应发生率无显著性差异(P>0.05)。结论全身性和吸入性糖皮质激素治疗AECOPD患者均能获得良好的治疗效果,可抑制炎性反应,改善肺功能,但雾化吸入的并发症少。
Objective To explore the influence of different administration modes of glucocorticoid on inflam-matory cytokines and lung function for AECOPD. Methods 94 AECOPD patients were randomly divided into three groups. On the basis of the treatment with antibiotics, antiasthma, phlegm and maintaining acid-base balance and other conventional treatment, the intravenous group （n=32） was given methylprednisolone 1 mg·kg-1·d-1 at the first 3days, 0. 5 mg·kg-1·d-1 at the next 4 days, the oral group （n=32） was given prednison 30-40mg/d for 7days, and the inhale group（n=30） was given budesonide 4mg/d, twice a day for 7 days. The change of inflamma-tory cytokines, lung function, and complications were observed. Results After treatment, the levels of inflammatory cytokines were all reduced in all groups, and there was no significant difference among the three groups （P〉0. 05）. After treatment, the lung function were all improved in all groups, FEV1% and FEV1/FVC in the intravenous group were significant better than those in the inhale group （P〈0. 05）, while the difference between the intravenous group and the oral group, the oral group and the inhale group was not significant （P〉0. 05）. The incidence of complica-tions in the inhale group was significantly lower than that in the intravenous group and the oral group （ P〈0. 05 ） , and there was no significant difference between the intravenous group and the oral group （P〉0. 05）. Conclusion Both systemic and inhaled glucocorticoid can achieve good clinical effect, contribute to inhibit inflammatory reaction, and improve lung function in treatment of AECOPD, but atomizing inhalation has fewer complications.
出处
《临床肺科杂志》
2016年第11期2018-2020,共3页
Journal of Clinical Pulmonary Medicine
