联合雾化吸入治疗在AECOPD中的临床疗效观察

Clinical Effects of Inhaling Budesonide, Terbutaline, Ipratropium Bromide and Ambroxol for Treatment of Acute Exacerbation of COPD

作者: 专业:临床医学 导师:姜淑娟 年度:2011 学位:硕士  院校: 山东大学

Keywords

COPD(chronic obstructive pulmonary disease), risk factors, inhaling therapy, clinical effects

        目的观察布地奈德混悬液联合硫酸特布他林溶液、异丙托溴铵溶液及盐酸氨溴索注射液雾化吸入在AECOPD中的临床疗效,评价68例AECOPD患者治疗前后临床症状、体征、动脉血气分析、PEF的改善状况及不良反应情况,并探讨影响COPD的相关危险因素。方法收集山东大学附属省立医院呼吸内科2010年9月至2011年3月68例慢性阻塞性肺疾病急性加重期住院患者,所有患者均给予常规治疗,包括持续低流量吸氧(1-2L/min)、静脉应用抗生素、解痉平喘、祛痰等治疗,同时注意补充营养,并对长期卧床、红细胞增多或脱水患者使用低分子肝素钠抗凝治疗,在此基础上将其随机分为2组:(1)试验组:加用布地奈德混悬液(普米克令舒)2mg、硫酸特布他林溶液(博利康尼)2.5mg、异丙托溴铵溶液(爱全乐)500ug及盐酸氨溴索注射液(沐舒坦)30mg联合氧驱动雾化吸入,氧流量6-8L/min,持续15-20分钟,2次/日,连续雾化吸入7天为一疗程,共34例,其中男性21例,女性13例,年龄47-83岁,平均68.3岁;(2)对照组:仅给予常规治疗,共34例,其中男性20例,女性14例,年龄40-85岁,平均64.8岁。根据两组患者治疗前后临床症状、体征评分、动脉血气分析、最大呼气流速(PEF)变化及住院天数、平均住院费用的比较,评价四联药物雾化吸入对AECOPD患者的临床疗效,同时注意其不良反应情况。并对68例患者的吸烟史、性别及年龄等相关因素进行分析,进而了解影响COPD的高危因素。结果1.高危因素分析:通过对68例患者的吸烟史、性别及年龄进行相关分析,表明:吸烟、年龄为COPD的主要危险因素,且发现吸烟指数与PEF值之间存在负相关直线关系,即随着吸烟强度的增加,PEF值逐渐降低,发生COPD的危险性也逐渐增高。根据COPD患者各年龄段人数所占比例,提示与年龄的不断增加相比较,COPD患病率也逐年增高。同时发现COPD患者男女性别比例存在显著差异,但因性别差异在很大程度上受吸烟因素的影响,经过本组研究,考虑造成COPD患者男女性别比例差异较大的原因可能是由于我国居民中男性吸烟率显著高于女性。2.各组内临床疗效比较:试验组及对照组治疗7天后各临床症状(咳嗽、咳痰、气促、肺部啰音)评分、动脉血气分析及PEF均较治疗前有显著性改善,其P值均<0.01,具有明显统计学差异。3.两组间临床疗效比较:两组治疗前后各临床症状、体征评分差值、动脉血气分析差值及PEF差值比较,试验组改善程度优于对照组,其差异具有统计学意义,同时得出试验组较对照组明显缩短患者住院天数,减少平均住院费用,具有统计学差异(P<0.05)。4.试验组和对照组退出率分别为8.1%和12.8%,差异无统计学意义(X2=0.087,P>0.05)。5.试验组和对照组的不良反应事件分别为4例和1例,总数差异无统计学意义(X2=1.943,P>0.05)。试验组的主要不良反应为恶心、口咽部不适,对照组出现的不良反应主要为胃部不适。结论1、吸烟和年龄两者均是COPD患病的高危因素。控制吸烟,尤其在老年男性能有效地预防肺功能的损伤,降低COPD的患病率。2、布地奈德混悬液联合硫酸特布他林溶液、异丙托溴铵溶液及盐酸氨溴索注射液雾化吸入能显著改善AECOPD患者的临床疗效。2.1四联药物混合后雾化吸入在减轻患者咳嗽、咳痰、气促、肺部啰音等临床症状、体征方面明显优于对照组。2.2四联药物混合后雾化吸入组与对照组相比较,病人治疗前后动脉血气分析各观察指标差值显著高于对照组,提示联合雾化吸入能明显提高动脉血氧分压,有效改善AECOPD的缺氧状况。2.3四联药物混合后雾化吸入治疗前后PEF差值较对照组显著提高,指示AECOPD联合雾化吸入能有效提高患者肺功能,改善其预后。3、布地奈德混悬液联合硫酸特布他林溶液、异丙托溴铵溶液及盐酸氨溴索注射液雾化吸入与对照组相比较,患者的住院天数明显缩短,且平均住院费用反而减少。4、布地奈德混悬液联合硫酸特布他林溶液、异丙托溴铵溶液及盐酸氨溴索注射液雾化吸入操作方便、不良反应少、安全性好,可作为COPD急性加重期的常规治疗。
    ObjectiveTo observe clinical effects and adverse reactions of inhaling budesonide, terbutaline, ipratropium bromide and ambroxol for treatment of acute exacerbations of COPD(AECOPD). And to investigate the risk factors of COPD.MethodsCollection data of 68 patients with AECOPD in Respiratory Medicine of Shandong Provincial Hospital affiliated to Shandong University, from November 2010 to March 2011. All patients were received conventional medical therapy, including continuous inhalation of oxygen(1-2L/min), anti-infection, antispasmodic and othetr supportive treatment. According to the order of admission,68 patients with AECOPD were randomly divided into 2 groups:(1) Treatment group:who received conventional medical therapy plus inhalation of budisonide 2mg, terbutaline 2.5mg, ipratropiium bromide 500μg and ambroxol 30mg,34cases, including 21 males and 13 females, mean age 68.3. (2)Control group:who received conventional medical therapy without inhalation,34 cases, including 20 males and 14 females, mean age 64.8. To observe the clinical effects of inhalation, the levels of clinical symptoms, signs, PEF and average hospital charges before and after treatment were compared in two groups. And the smoking history, gender and age-related factors were analyzed to study the risk factors of COPD.Results1. Risk factors:through analysis, smoking and age were the major risk factors, and PEF and the smoking index had the negative correlation. According to the proportion of people, COPD prevalence was also increasing with age increasing. Through there were significantly difference in gender, we considered that the reason was male smoking rate significantly higher than women.2. Clinical efficacy:after treatment, the clinical symptoms(cough, sputum, dyspnea and rales) and PEF in two groups were significantly improved(P<0.01).3. Compare to control group cases, the difference of treatment group cases had been significantly increased after treatment(P<0.05), and the average hospital charges were lower than the control group. The diffenrence was significant(P<0.05).4. The quit rates of the treatment groups(namely for mortality) were 8.1%, lower than control group (12.8%), but the difference was not statistically significant (χ2= 0.087, P>0.05).5. Adverse events in treatment group and control group were 4 cases and 1 case, there was no significant difference between the total (χ2=1.943,P>0.05). The main side effects in treatment group were nausea and oropharyngeal discomfort, the control group’s main adverse reactions was stomach discomfort.Conclusions1. Smoking and age were the major risk factors. Controling of smoker can significantly improve pulmonary function.2. Inhalation of four drugs can significantly improve the clinical effects in acute exacerbation of COPD.2.1 Inhalation can be obviously better than the control group in relieving the clinical symptoms of AECOPD.2.2 Compared with the control group, united inhalation can be more significant improvement in hypoxia, increased arterial blood gas analysis.2.3 PEF difference before and after inhalation was significantly increased compared with the control group, indicating that the united inhalation can increase lung function and improve the prognosis.3. Inhalation of four drugs can obviously reduce the treatment days and cost.4. Inhalation of four drugs is easy to use, safety. It can be used for the conventional treatment in AECOPD.
        

联合雾化吸入治疗在AECOPD中的临床疗效观察

中文摘要6-9
ABSTRACT9-11
符号说明12-14
前言14-18
资料与方法18-23
结果23-30
讨论30-35
结论35-36
附图36-38
参考文献38-42
综述42-57
    参考文献52-57
致谢57-58
学位论文评阅及答辩情况表58
        


本文地址:

上一篇:莫西沙星血液与腹腔引流液中的药代动力学与药效学评价
下一篇:去氨加压素和垂体后叶素对肝星状细胞增殖、收缩及分泌的影响研究

分享到: 分享联合雾化吸入治疗在AECOPD中的临床疗效观察到腾讯微博           收藏
评论排行
公告