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目的对比观察不同疗程糖皮质激素治疗重症慢性阻塞性肺疾病(COPD)急性加重期患者的疗效及安全性。方法选择因COPD急性加重而入住ICU的137例患者,随机分为短疗程组68例和常规疗程组69例,所有患者均在第1天接受40mg甲基强的松龙静脉注射,第2~5天口服强的松40mg/d。常规治疗组在第6~14天继续口服强的松40mg/d,短程治疗组患者在第6~14天服用安慰剂。观察2组患者肺功能、动脉血气分析指标改善情况及不良反应发生情况,比较2组患者临床疗效及病死率。结果治疗后2组患者肺功能、动脉血气分析指标均显著改善(P<0.05),2组间比较差异无统计学意义(P>0.05);短程治疗组不良反应发生率低于常规治疗组(P<0.05);2组总有效率、病死率和6个月复发率比较差异无统计学意义(P>0.05)。结论适当缩短应用甲泼尼龙治疗COPD急性加重期患者的疗程,可减少不良反应,且不影响临床疗效,值得临床推广应用。
Objective To compare the efficacy and safety of different courses of glucocorticoid in the treatment of patients with severe chronic obstructive pulmonary disease (COPD) in acute exacerbation. Methods A total of 137 patients admitted to ICU due to acute exacerbation of COPD were randomly divided into a short course of 68 cases and a conventional treatment of 69 cases. All patients received intravenous injection of 40 mg methylprednisolone on day 1, 5 days oral prednisone 40mg / d. Patients in the conventional treatment group continued oral prednisone 40 mg / d on days 6-14 and patients in the brachytherapy group took placebo on days 6-14. Two groups of patients were observed pulmonary function, arterial blood gas analysis of indicators to improve the situation and adverse reactions, the clinical efficacy and mortality in two groups were compared. Results After treatment, the indexes of lung function and arterial blood gas were significantly improved in both groups (P <0.05), but there was no significant difference between the two groups (P> 0.05). The incidence of adverse reactions in short-term treatment group was lower than that in routine treatment group P <0.05). There was no significant difference in total effective rate, case fatality rate and 6-month recurrence rate between the two groups (P> 0.05). Conclusions Appropriate shortening of the course of treatment of patients with acute exacerbation of COPD by methylprednisolone can reduce the adverse reactions, and does not affect the clinical efficacy, it is worthy of clinical promotion and application.