高原地区老年慢性肺心病重度急性加重期患者糖皮质激素的应用  

Application of systemic glucocorticoids for severe exacerbations of elderly patients with chronic cor pulmonale in high altitude area

作　　者：杨生岳[1] 冯恩志[1] 祁玉曙[1] 张瑛[1] 高玲[1] 董红梅[1] 

机构地区：[1]解放军第四医院兰州军区呼吸内科中心,青海省西宁市810014

出　　处：《中华老年医学杂志》2003年第2期69-72,共4页Chinese Journal of Geriatrics

基　　金：解放军总后勤部卫生’ 95重点科研课题 (96D0 47)

摘　　要：目的　探讨高原老年慢性肺心病因呼吸道感染致重度急性加重期患者应用肾上腺糖皮质激素 3d和 10d对减轻气道阻塞、改善气体交换和症状的效果。　方法　 78例患者随机分为 2组 ,Ⅰ组 (3 9例 )仅前 3d静脉滴注地塞米松 0 2mg/kg ,1次 / 12h ,随后 7d改用生理盐水 ,Ⅱ组 (3 9例 )前 3d静脉滴注地塞米松 0 2mg/kg ,1次 / 12h ,随后 3d为0 1mg/kg ,1次 / 12h ,最后 4d为0 1mg/kg,1次 /d。治疗期间 2组患者均口服相同剂量的舒喘灵、氨茶碱、必嗽平和西咪替丁 10d ,选用敏感抗生素。治疗前、治疗 3d、10d后分别测定肺功能、动脉血气 ,并观察呼吸困难、咳嗽、咳痰的变化。　结果　治疗 3d ,Ⅰ组 1s用力呼气容积占预计值百分比 (FEV1% )、动脉血氧分压 (PaO2 )、动脉血二氧化碳分压 (PaCO2 )分别为 (3 5 9± 7 6) %、(44 4± 5 8)mmHg、(46 1± 5 8)mmHg ,Ⅱ组分别为 (3 4 8± 7 3 ) %、(45 0± 5 7)mmHg、(46 9± 5 0 )mmHg ;治疗 10d后 ,Ⅰ组 3项指标分别为(3 6 7± 7 6) %、(45 6± 6 1)mmHg、(44 8± 5 2 )mmHg ,Ⅱ组分别为 (42 0± 7 1) %、(49 7± 6 3 )mmHg、(41 7± 4 2 )mmHg ,与治疗前比较均为P <0 0 1。治疗 3d时 ,两组患者的症状评分、FEV1%、FEV1/用力肺活量 (FVC)比值、PaO2 。Objective To compare the efficacy of 3 day and 10 day courses of systemic administration of glucocorticoids in severe exacerbations of elderly patients with chronic cor pulmonale in high altitude area(HACCP). Methods 78 patients with severe excerbations of HACCP were assigned randomly to two groups. Group Ⅰ(39 cases) received dexamethasone, 0 2 mg/kg in intravenous guttae(iv gtt) q12h for 3 days, followed by saline iv gtt twice daily for the following 3 days and once daily for final 4 days. Group Ⅱ(39 cases) received dexamethasone, 0 2 mg/kg iv gtt q12h for the first 3 days, followed by 0 1 mg/kg iv gtt twice daily for 3 days and 0 1 mg/kg iv gtt once daily for final 4 days. Before therapy and on day 3, day 10 after therapy, the pulmonary function, arterial blood gas, the scores of dysnea, cough and sputum were examined. Results On day 3 after therapy, FEV 1 %, PaO 2 and PaCO 2 in group Ⅰ were ( 35 9 ±7 6)%, (44 4±5 8)mm Hg and (46 1±5 8)mm Hg, respectively. Those in group Ⅱ were (34 8±7 3)%,(45 0±5 7)mm Hg and (46 9±5 0)mm Hg, respectively. On day 10 after therapy, those in group Ⅰ were (36 7± 7 6 )%, (45 6±6 1)mm Hg and (44 8±5 2)mm Hg, and those in group Ⅱ were (42 0±7 1)%,(49 7±6 3)mm Hg and (41 7±4 2)mm Hg, respectively. Parameters in two groups were different markedly compared with those before therapy(all P <0 01). Symptoms, FEV 1 %, FEV 1 /FVC, PaO 2 and PaCO 2 in two groups were all improved signifisantly on day 3 after therapy. Those parameters in group Ⅱ, but not in group Ⅰ, were improved continuously till day 10 after therapy. Conclusions Short term systemic application of glucocorticoids in severe exacerbations of elderly patients with HACCP is efficacious and safe; the 10 day course of glucocorticoids treatment is more effective than the 3 day course in improving pulmonary ventilation, blood gas and symptoms.

关 键 词：阻塞性肺疾病 肺心病 糖皮质激素类 高海拔 

分 类 号：R541.5[医药卫生—心血管疾病]