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目的观察静注甲泼尼龙与雾化吸入布地奈德在治疗慢性阻塞性肺病急性加重期(AE-COPD的疗效及安全性。方法 109例患者随机分为常规治疗组(N组)、甲泼尼龙组(P组)、雾化吸入布地奈德组(B1组、B2组)4组,均常规给予抗感染、化痰、吸氧、雾化吸入支气管扩张剂等治疗7d。其中,P组给予甲基强的松龙针40mg静注,2次/d;B1组给予布地奈德混悬液(普米克令舒)1mg,bid氧驱动雾化;B2组给予布地奈德混悬液(普米克令舒)2mg,tid氧驱动雾化。分别在治疗前、后观察各组FEV1、FVC、PaO2、PaCO2、血糖、临床评分等指标,并行统计分析。结果各组治疗后临床评分、FEV1、FVC、PaO2、PaCO2均较治疗前有改善,P<0.05;P组、B1组和B2组较N组改善更为明显,差异有显著性(P<0.05);B1组与B2组之间无统计学意义(P>0.05);各组治疗结束后血糖增高情况分别为N组1例(4.0%),P组7例(24%),B11例(3.7%)、B2组2例(7.1%),N组与其他组有显著差异,P<0.05。结论 AECOPD在常规治疗基础上使用静注或雾化吸入糖皮质激素均能改善临床症状和肺功能,并可纠正低氧、高碳酸血症;雾化吸入高剂量与低剂量的糖皮质激素疗效相当;雾化吸入糖皮质激素所致的血糖增高明显低于静注糖皮质激素。
Objective To observe the efficacy and safety of intravenous methylprednisolone and inhaled budesonide in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) .Methods 109 patients were randomly divided into routine treatment group (N group), methylprednisolone N group (group P), inhalation of budesonide group (group B1, group B2) were given anti-infection, phlegm, oxygen, inhalation bronchodilator and other treatment for 7 days.P group Given methylprednisolone needle 40mg intravenously, 2 times / d; B1 group budesonide suspension (Pulmicort Resp.) 1mg, bid oxygen driven atomization; B2 group budesonide suspension Pulmicort respules 2mg, tid oxygen driven atomization respectively before and after treatment were observed FEV1, FVC, PaO2, PaCO2, blood glucose, clinical scores and other indicators, and statistical analysis.Results After treatment, the clinical score, FEV1 , FVC, PaO2, PaCO2 were improved than before treatment, P <0.05; P group, B1 group and B2 group improved more significantly than the N group, the difference was significant (P <0.05); B1 group and B2 group (P> 0.05). The increase of blood glucose after the treatment in each group was N in 1 case (4.0%), P in 7 cases (24%), B11 cases (3.7%), B2 group in 2 cases 7.1%), N group and others Group, P <0.05.Conclusion AECOPD can improve clinical symptoms and pulmonary function by using intravenous injection or inhalation of glucocorticoid on the basis of routine treatment, and can correct hypoxemia and hypercapnia; Dose and low doses of glucocorticoids efficacy; inhaled glucocorticoid inhaled blood glucose was significantly lower than intravenous glucocorticoid.