糖皮质激素在COPD急性加重期的近远期疗效及安全性  

Efficacy and safety of corticosteroid in patients with acute exacerbation of COPD

作　　者：苏长海[1] 任水明[2] 

机构地区：[1]鄂尔多斯市中心医院药剂科,内蒙古鄂尔多斯017000 [2]鄂尔多斯市中心医院呼吸内科,内蒙古鄂尔多斯017000

出　　处：《中国临床药理学杂志》2012年第4期253-255,268,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的评价不同剂量糖皮质激素对慢性阻塞性肺疾病(COPD)急性加重期的住院患者近期、远期疗效及安全性。方法 82名患者随机分为2组,低剂量组静滴甲基强的松龙40 mg.d-1,连续6 d;第7～9 d,给强的松片15 mg;第9～12 d,给强的松5 mg。高剂量组静滴甲基强的松龙2 mg.kg-1.d-1,分2次给药,连续3 d;第4～6 d,按1.5 mg.kg-1.d-1,分2次给药;第7～9 d,口服强的松片30 mg;第9～12 d,口服强的松10 mg。2组同时给吸氧、抗感染药物、雾化支气管舒张剂。结果 90 d随访期内,低与高剂量组治疗失败率无统计学意义(P>0.05)。在给药后24,72 h,高剂量组的氧分压(PaO2)、第1 s用力呼气量(FEV1)、血氧饱和度(SaO2)和各项气短指数的改善幅度均优于低剂量组(P<0.05或P<0.01)。但给药后72 h,对二氧化碳分压(PaCO2)、痰量和咳嗽程度的影响,2剂量组差异无统计学意义。出院时上述各项指标2组没有显著性差异。高剂量组住院天数较低剂量组短,但无统计学意义(P>0.05)。高剂量组不良反应发生率较低剂量组高(P<0.05)。结论近期疗效(入院72 h),高剂量组优于低剂量组;远期疗效(90 d随访期),不同剂量无显著性差异。Objective To evaluate the short-and long-term efficacy and safety of high-dose and low-dose corticosteroid regimens in the treatment of patients hospitalized with chronic obstructive pulmonary disease（COPD）.MethodsCOPD patients who met the inclusion criteria were randomly assigned to one of two treatment groups： low-dose group received 40 mg methylprednisolone（MP） once daily for the first 6 days,followed by once-daily oral prednisone（15 mg on day 7 through day 9,5 mg on day 10 through day 12）,high-dose group received intravenous MP（2 mg·kg-1·d-1 for the first three days,1.5 mg·kg-1·day-1on day 4 through day 6） followed by once-daily oral prednisone（30 mg on day 7 through day 9,10 mg on day 10 through day 12）.They were all given inhaled bronchodilator,antibiotics and controlled oxygen therapy.ResultsOur study showed treatment failure rates did not differ significantly during three months.Although initial spirometric and arterial blood gas parameters were similar between the groups,absolute values after 24 h were better in high-dose group than in low-dose group.The mean score of cough,sputum volume and PaCO2 level improved similarly in the two groups from day 1 to the hospital discharge.There were also no differences in mean length of hospital stay between the two groups.The patients who received high-dose corticosteroid regimens were more likely to have nervous system and gastrointestinal tract disorder than those who received low-dose regimens.ConclusionIn early treatment,the efficacy of high-dose corticosteroid regimens is better than low-dose group,while the efficacy is no difference between two groups in late treatment.Because incidence of side effect is higher in high-dose group,doctors should properly choose dose of corticosteroid.

关 键 词：糖皮质激素 慢性阻塞性肺疾病 

分 类 号：R977.1[医药卫生—药品] R563.9[医药卫生—药学]