【摘要】：目的:探討糖皮質(zhì)激素5 d和15 d給藥方案對(duì)老年慢性阻塞性肺疾病急性加重期(AECOPD)患者臨床療效、肺功能和生活質(zhì)量的影響及用藥安全性。方法:選取�？谑械谒娜嗣襻t(yī)院2013年5月-2015年12月收治的老年AECOPD患者160例,按抽簽法分為A組和B組,各80例。入選患者均給予祛痰平喘、控制感染等對(duì)癥治療。在此基礎(chǔ)上,A組患者給予注射用甲潑尼龍琥珀酸鈉40 mg/d,連用15 d,B組患者給予注射用甲潑尼龍琥珀酸鈉40 mg/d,連用5 d。比較兩組患者的臨床療效,治療前后的肺通氣功能指標(biāo)水平、血?dú)夥治鲋笜?biāo)水平和Spitzer生活質(zhì)量指數(shù)量表(QLI)評(píng)分,以及不良反應(yīng)發(fā)生情況。結(jié)果:A組患者的總有效率為92.50%,B組為90.00%,兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療前,兩組患者的肺通氣功能指標(biāo)水平、血?dú)夥治鲋笜?biāo)水平和QLI評(píng)分比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療后,兩組患者的用力肺活量、第1秒用力呼氣量(FEV1)、FEV1占預(yù)計(jì)值百分比和氧分壓均明顯高于治療前,二氧化碳分壓均明顯低于治療前,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),但組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者的QLI評(píng)分均明顯高于治療前,且B組明顯高于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。B組患者的不良反應(yīng)發(fā)生率(6.25%)明顯低于A組(22.50%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:糖皮質(zhì)激素5 d和15 d給藥方案在改善老年AECOPD患者肺功能方面的療效接近,但5 d給藥方案更能有效提高患者的生活質(zhì)量、降低不良反應(yīng)發(fā)生風(fēng)險(xiǎn),更具臨床應(yīng)用價(jià)值。
[Abstract]:Objective: to investigate the effects of glucocorticoid on the clinical efficacy, pulmonary function, quality of life and safety of medication in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after 5 and 15 days of administration of glucocorticoid. Methods: 160 elderly AECOPD patients admitted to Haikou fourth people's Hospital from May 2013 to December 2015 were divided into group A and group B by drawing lots. Selected patients were given expectorant asthma, control infection and other symptomatic treatment. On this basis, patients in group A were given 40 mg / d methylprednisolone sodium succinate for injection, and patients in group B were given 40 mg / d of sodium methylprednisolone succinate for 5 days. The clinical efficacy, pulmonary ventilation function index, blood gas analysis index and Spitzer quality of life index (QLI) score before and after treatment were compared between the two groups, as well as the occurrence of adverse reactions. Results the total effective rate of group A was 92.50 and that of group B was 90.00.The difference between the two groups was not statistically significant (P0.05). Before treatment, there was no significant difference in pulmonary ventilation function, blood gas analysis and QLI score between the two groups (P0.05). After treatment, the forced vital capacity, FEV1 / FEV1 percentage and oxygen partial pressure in both groups were significantly higher than those before treatment, and the partial pressure of carbon dioxide was significantly lower than that before treatment. The differences were statistically significant (P0.05), but there was no significant difference between the groups (P0.05). The QLI scores of the two groups were significantly higher than those of the patients before treatment, and group B was significantly higher than group A, the difference was statistically significant (P0.05). The incidence of adverse reactions in group B (6.25%) was significantly lower than that in group A (22.50%), and the difference was statistically significant (P0.05). Conclusion: the effects of glucocorticoid administration on lung function in aged patients with AECOPD for 5 and 15 days are similar, but 5-day regimen is more effective to improve the quality of life, reduce the risk of adverse reactions, and have more clinical application value.
【作者單位】： �？谑械谒娜嗣襻t(yī)院急診科;海南醫(yī)學(xué)院附屬醫(yī)院急診ICU;
【分類號(hào)】：R563.9

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