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目的 :评价甲基强地松龙 (甲强龙 )序贯治疗重度和危重度慢性阻塞性肺疾病急性发作(COPD- AE)的疗程、疗效及药物经济学。方法 :随机平行对照、开放、多中心研究 ,重度、危重度COPD急性发作住院患者 16 1例。A、B组应用甲强龙 80mg静脉滴注bid ,4d后口服甲强龙片 8mgbid ,A组 5d ,B组 10d ;C组口服甲强龙片 16mgbid 14d。 3组均同步应用抗生素、支气管扩张剂及祛痰药。结果 :3组治疗后症状评分、1s用力呼气容积 (FEV1 )、FEV1 %、氧分压 (PaO2 )、二氧化碳分压 (PaCO2 )均较治疗前显著改善 ,3组间比较差异均无显著性。A、B组治疗中期及治疗后用力肺活量 (FVC)显著增加。治疗后A、B、C组病情改善率分别为 5 1. 5 %、4 8. 4 %和 39 .4 %。A、B组症状体征起效时间为 2d ,但仅咳嗽症状改善显著快于C组。A组 9d疗程药费为 372 3 3元显著低于B组 (5 4 94元 )和C组 (5 0 4 1 .1元 ) ,同时陪护费、误工费减少 5d。结论 :甲强龙序贯治疗 9d与序贯治疗 14d或口服 14d疗效相似 ,且起效快、费用低 ,值得推广。
Objective: To evaluate the course, efficacy and pharmacology of methylprednisolone (methylprednisolone) in the sequential treatment of severe and severe chronic obstructive pulmonary disease (COPD-AE). Methods: Randomized controlled, open, multicentre study, severe and severe acute exacerbation of COPD in hospitalized patients 16 1 cases. Group A and group B were treated with methylprednisolone 80mg intravenously for bid, 4 days after oral administration of methylprednisolone 8mgbid, group A for 5 days and group B for 10 days. Group C received methylprednisolone 16mgbid for 14 days. Three groups were simultaneously applied antibiotics, bronchodilators and expectorants. Results: After treatment, symptom score, FEV1, FEV1%, PaO2 and PaCO2 in three groups were significantly improved compared with those before treatment, and there were no significant differences among the three groups . A, B group during and after treatment of forced vital capacity (FVC) increased significantly. After treatment, the improvement rates of A, B and C groups were 51.5%, 48.4% and 39.4% respectively. A, B group signs and symptoms onset time of 2d, but only cough symptoms improved significantly faster than C group. In group A, the cost of medication for 9 days was 372.33 yuan, which was significantly lower than that of group B (5494 yuan) and group C (504.01 yuan), while the escort fee and the loss of working time cost were reduced by 5 days. Conclusion: Sequential treatment with methylprednisolone for 9 days is similar to sequential treatment for 14 days or oral administration for 14 days, and has rapid onset and low cost, which deserves promotion.