局部和全身用激素治疗COPD急性加重临床比较.docVIP

局部和全身用激素治疗COPD急性加重临床比较 　　中图分类号：R563 　　文献标识码： A 　　文章编号： 1672-3783(2008)-9-0020-03? 　　【摘 要】 目的 观察布地奈德雾化对慢性阻塞性肺病(COPD)急性加重期患者治疗的临床疗效。方法 90例COPD急性加重期(肺功能FEV1在60%~25%)住院患者随机分为地奈德雾化治疗组、甲强龙针剂静脉滴注组和对照组。观察3组患者在入院时、入院第3天和第5天的临床表现、肺功能和动脉血气变化及副作用情况。结果 入院后第3天布地奈德组和甲强龙组的临床评分、PaCO2改善程度均优于空白对照组(P2,PaCO2改善程度均明显优于对照组(P0.05)。布地奈德组的副作用明显少于甲强龙组(P0.05)。结论 布地奈德雾化治疗是COPD急性加重期患者激素治疗的有效选择。? 　　【关键词】慢性阻塞性肺病 急性加重期 布地奈德 甲强龙 　　 　　Clinical Comparison of Using Dexamethasone by Local? 　　and Systemic method in the treatment of Acute Exacerbation of COPD? 　　WU Jin-zhu? 　　XuYi County Peoples Hospital ,XuYi 211700,Jiangsu , China 　　【Abstract】Objective To evaluate the effect of Nebulized Budesonide (NB) in treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD).MethodsNinety COPD patients with acute exacerbation and lung function FEV1of 60%-25% were randomized into 3 groups: nebulized Budesonide(NB) group ,Methylprednisolone( MP) group and placebo-control group. The dyspnea score, post-bronchodilator FEV1, arterial blood gas analysis were measured in admission (d0) and d3,d5 of admission. And the adverse effects were evaluated at the same time. Data w ere statistically analyzed by SPSS windows 11.5software. Results The changes of dyspnea score and PaCO2 at d3 in patients with active treatments were greater than those in placebo group (P0.05).The adverse effect in NB group was similar to that in placebo group and less than that in MP group. Conclusion Both NB and Methylprednisolone improved airflow obstruction in COPD patients with acute exacerbation when compared with placebo.? 　　【Key words】Chronic obstructive pulmonary disease;Acute exacerbation;Budesonide;Methylprednisolone 　　 　　慢性阻塞性肺病(COPD)是一种常见病、多发病，全身性激素联合支气管扩张剂、抗感染等治疗可促进COPD急性加重患者症状的快速恢复，缩短住院时间，在临床上已达??共识[1]。但由于COPD急性加重期患者常合并反复呼吸道感染，且又多为老年人，使用全身激素可出现诸多如高血糖、感染加重、肌萎缩等不良反应，因而使用受到了限制。吸入激素治疗可在局部保持较高的浓度，产生有效的抗炎效应，尤其对全身的影响小。全球哮喘防治创议(GINA)推荐吸入性激素可以取代口服与静脉内使用激素来治疗哮喘的急性发作[2]，而COPD与支气管哮喘均属气流受限的慢性气道炎症疾病。为比较吸入激素是否也可以取代全身性激