动态监测FeNO对AECOPD患者全身静脉糖皮质激素应用的作用  

Dynamic monitoring of FeNO to guide the application of systemic venous glucocorticoid in patients with AECOPD

作　　者：孙广信 李宝珠[1] 李想 王锦涛[1] Sun Guangxin;Li Baozhu;Li Xiang;Wang Jintao(Department Of Pulmonary, the First People's Hospital of Zhengzhou, Zhengzhou 450004, China)

机构地区：[1]郑州市第一人民医院呼吸内科,河南郑州450004

出　　处：《河南医学研究》2018年第20期3673-3676,共4页Henan Medical Research

摘　　要：目的探索动态监测呼出气一氧化氮(FeNO)水平在指导慢性阻塞性肺疾病急性加重(AECOPD)患者全身静脉糖皮质激素治疗用药的作用。方法选取2016年12月至2018年2月郑州市第一人民医院收治的80例AECOPD患者,纳入AECOPD组,按FeNO指导与否分为FeNO指导组(40例)和非FeNO指导组(40例),另选取同时期同家医院门诊就诊的40例COPD稳定期患者纳入对照组。AECOPD患者接受扩张气道、止咳化痰、抗感染及营养支持等常规基础治疗。FeNO指导组依动态FeNO水平决定激素的治疗选择,非FeNO指导组则根据症状、体征等判断激素的用药。激素为甲强龙针40~80 mg/d。观察FeNO水平、激素用量用时、激素应用率、症状缓解时间、住院天数及药物不良反应发生等情况。结果 AECOPD组FeNO水平高于对照组,差异有统计学意义(P <0. 05)。FeNO指导组患者激素应用天数短于非FeNO指导组,激素应用总量少于非FeNO指导组,全身激素应用率低于非FeNO指导组,差异有统计学意义(P <0. 05)。FeNO指导组患者咳嗽、胸闷、气喘的缓解时间短于非FeNO指导组,住院天数短于非FeNO指导组,药物不良反应发生率低于非FeNO指导组,差异有统计学意义(P <0. 05)。结论动态监测FeNO对指导AECOPD患者全身静脉糖皮质激素的应用有临床价值,值得临床推荐。Objective To explore the role of the level of fractional exhaled nitric oxide (FeNO) by dynamic monitoring in guiding the application of systemic venous glucocorticoid in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 80 patients with AECOPD in Zhengzhou First People ' s Hospital from December of 2016 to February of 2018 were selected and included in AECOPD group. They were divided into FeNO guidance group (40 cases) and non-FeNO guidance group (40 cases) according to whether FENO guidance or not. Forty patients with stable COPD who visited the clinic in the same hospital at the same time were selected and included in control group. All patients with AECOPD were given routine basic treatment, such as anti-infection, dilated airway, reducing sputum, relieving cough and nutritional support. The patients in FeNO guidance group were determined the selection of the systemic venous hormone according to the dynamic level of FeNO. The selection of hormone of patients in non-FeNO guidance group was determined by the doctors ' subjective judgment according to the clinical symptoms and signs. The dose of systemic venous hormone was 40 mg to 80 mg every day. The levels of FeNO, the amounts of hormone used, the rate of hormone use, the time to relieve symptoms, the number of days in hospital and the occurrence of adverse drug reactions were observed. Results The level of FeNO in AECOPD group was higher than that in control group, and the difference was statistically significant (P <0.05 ). Compared with non-FeNO guidance group, in FeNO guidance group, the number of days of hormone application was shorter, less in the total amount of hormone application, lower in the rate of systemic hormone application, and the differences were statistically significant (P <0.05 ). The remission time of cough, chest distress and asthma and the hospitalization time in FeNO guidance group were shorter than those in non-FeNO guidance group, and the incidence of adverse drug reactions was lo

关 键 词：慢性阻塞性肺疾病急性加重 糖皮质激素 呼出气一氧化氮 

分 类 号：R563.9[医药卫生—呼吸系统]