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目的:探讨不同激素方案治疗高龄慢性阻塞性肺疾病患者急性加重期(AECOPD)的临床疗效。方法:90例高龄AECOPD患者随机分为3组,每组各30例,均给予吸氧、抗生素、祛痰药、支气管扩张剂等常规治疗;雾化组给予布地奈德混悬液2 mg雾化吸入,每8 h一次;静脉组给予甲基强的松龙针剂40mmg静脉推注,每日1次;对照组不使用激素。7 d为一疗程。比较3组的疗效、MRC评分、血气分析、肺功能、空腹血糖、餐后血糖和不良反应。结果:治疗后,雾化组和静脉组的总有效率、呼吸困难评定分级均显著高于对照组(P<0.05);3组肺功能指标FEV_1Fred和血气分析各指标均有明显改善,雾化组、静脉组各指标显著优于对照组(P<0.05);雾化组血糖升高率与对照组无明显差别,静脉纽的血糖升高率均显著高于对照组和雾化组(P<0.05)。雾化组不良反应发生率与对照组无明显差异,静脉组的发生率均显著高于对照组和雾化组(P<0.05)。结论:雾化吸入高剂量激素、全身静脉激素对AECOPD高龄患者疗效相当,均能明显改善患者的肺功能和动脉血气,雾化吸入激素的全身不良反应更低,建议可取代静脉激素作为AECOPD高龄患者的首选治疗方案。
Objective: To investigate the clinical effects of different hormonal regimens in the treatment of acute exacerbation (AECOPD) in elderly patients with chronic obstructive pulmonary disease. Methods: Ninety elderly patients with AECOPD were randomly divided into three groups, 30 patients in each group. All patients were given conventional therapy such as inhalation of oxygen, antibiotics, expectorants and bronchodilators. In the nebulized group, 2 mg of budesonide suspension Inhalation, once every 8 h; intravenous group given methylprednisolone 40mmg intravenous injection, 1 day; the control group did not use hormones. 7 d for a course of treatment. The curative effect, MRC score, blood gas analysis, lung function, fasting blood glucose, postprandial blood glucose and adverse reactions were compared between the three groups. Results: After treatment, the total effective rate and dyspnea rating of the atomization group and the venous group were significantly higher than those of the control group (P <0.05). The indexes of FEV 1 Red and blood gas analysis of 3 groups were significantly improved, (P <0.05). There was no significant difference in the rate of hyperglycemia in the nebulized group compared with that in the control group (P <0.05). The rate of hyperglycemia in the neovascular group was significantly higher than that in the control group and the nebulized group <0.05). There was no significant difference between the two groups in incidence of adverse reactions in the nebulized group and the control group. The incidence of venous group was significantly higher than that in the control group and nebulized group (P <0.05). Conclusion: Inhalation of high dose of hormones and systemic intravenous hormones has the same curative effect on elderly patients with AECOPD, can significantly improve the patient’s pulmonary function and arterial blood gas, systemic adverse effects of inhaled hormones lower, suggesting that instead of intravenous hormones as AECOPD age The patient’s preferred treatment.