作者：徐琳琳，周瑞清，郑法德，赵军，邢青峰，冉献贵

单位：

236000 安徽省阜阳市人民医院呼吸与危重症医学科

Units：

Department of Respiratory and Critical Care Medicine, Fuyang People's Hospital, Fuyang 236000, China

关键词：

慢性阻塞性肺疾病；急性加重期；糖皮质激素；特布他林；治疗结果；血气分析指标

Keywords：

Chronic obstructive pulmonary diseases; Acute exacerbation; Glucocorticoids; Terbutaline; Treatment outcome; Blood gas analysis index

CLC：

R 563.9　

DOI：

10.12114/j.issn.1008-5971.2021.00.094

Funds：

摘要：

背景　慢性阻塞性肺疾病（COPD）是临床常见的一种呼吸系统疾病，由慢性支气管炎或肺气肿所致， 且呈进行性进展。COPD 急性加重患者可出现小气道狭窄、闭塞，致使肺通气障碍，严重者可能进展为右心衰竭，威 胁患者的生命。目的　探讨糖皮质激素联合特布他林雾化吸入治疗COPD 急性加重患者的临床疗效及其对肺功能的影 响。方法　选取2018 年10 月—2020 年10 月阜阳市人民医院收治的COPD 急性加重患者82 例，采用随机数字表法分 为对照组和研究组，每组41 例。患者入院后即给予常规对症治疗，在此基础上，对照组患者采用布地奈德混悬液雾 化吸入治疗，研究组患者在对照组基础上采用特布他林雾化吸入治疗，两组患者均持续治疗7 d。比较两组患者的临 床疗效和治疗前后肺功能指标、嗜酸粒细胞直接计数，血清内皮素1（ET-1）、Ⅹ a 水平，日常生活活动能力（ADL） 量表评分、改良呼吸困难指数（mMRC）评分及不良反应发生率。结果　研究组患者临床疗效优于对照组（P ＜ 0.05）。 两组患者治疗前最大呼气流速（PEF）、用力肺活量（FVC）、第1 秒用力呼气容积（FEV1）、通气量（VE）、血氧 饱和度（SpO2）、呼气末二氧化碳分压（PE-TCO2）、潮气量（VT）及治疗后FVC比较，差异无统计学意义（P ＞ 0.05）； 研究组患者治疗后PEF、FEV1、VE、SpO2、VT 高于对照组，PE-TCO2 低于对照组（P ＜ 0.05）。两组患者治疗后 PEF、FVC、FEV1、VE、SpO2、VT 分别高于本组治疗前，PE-TCO2 分别低于本组治疗前（P ＜ 0.05）。两组患者治疗 前嗜酸粒细胞直接计数及血清ET-1、Ⅹ a 水平比较，差异无统计学意义（P ＞ 0.05）；研究组患者治疗后嗜酸粒细胞 直接计数及血清ET-1、Ⅹ a 水平低于对照组（P ＜ 0.05）。两组患者治疗后嗜酸粒细胞直接计数及血清ET-1、Ⅹ a 水平分别低于本组治疗前（P ＜ 0.05）。两组患者治疗前ADL量表评分、mMRC评分比较，差异无统计学意义（P ＞ 0.05）； 研究组患者治疗后ADL 量表评分高于对照组，mMRC 评分低于对照组（P ＜ 0.05）。两组患者治疗后ADL 量表评分 分别高于本组治疗前，mMRC 评分分别低于本组治疗前（P ＜ 0.05）。两组患者不良反应发生率比较，差异无统计学 意义（P ＞ 0.05）。结论　糖皮质激素联合特布他林雾化吸入治疗COPD 急性加重患者的临床疗效确切，可有效改善 患者的肺功能及呼吸困难症状，提高患者的ADL，降低急性加重风险，且安全性高。

Abstract：

　Background　Chronic obstructive pulmonary disease (COPD) is a common clinical progressive respiratory disease, caused by chronic bronchitis or emphysema. Acute exacerbation of COPD patients may appear small airway stenosis and occlusion, resulting in pulmonary ventilation disorders. Severe cases may progress to right heart failure, threatening the patient's life. Objective　To investigate the clinical efficacy of atomization inhalation of glucocorticoid combined with terbutaline in the treatment of acute exacerbation of COPD patients and its impact on pulmonary function. Methods　A total of 82 cases of patients with acute exacerbation of COPD admitted to Fuyang People's Hospital from October 2018 to October 2020 were selected and randomly divided into control group and study group, with 41 cases in each group. All patients were given routine symptomatic treatment. On this basis, patients in the control group were treated with atomization inhalation therapy of budesonide, while patients in the study group were given atomization inhalation therapy of terbutaline based on control group. Both groups were treated for 7 days. The clinical efficacy, pulmonary function indexes, direct eosinophil count, serum endothelin-1 (ET-1) , Ⅹ a levels, scores of activities of daily living ability (ADL) scale, modified British medical research council (mMRC) before and after treatment and incidence of adverse reactions were compared between the two groups. Results　Clinical efficacy of the study group was better than that of the control group (P < 0.05) . There were no significant differences in the maximum expiratory flow (PEF) , forced vital capacity (FVC) , forced expiratory volume in the first second (FEV1) , ventilation volume (VE) , blood oxygen saturation (SpO2) , partial pressure of carbon dioxide at the end of expiratory breath (PE-TCO2) and tidal volume (VT) before treatment and FVC after treatment between the two groups (P > 0.05) ; after treatment, PEF, FEV1, VE, SpO2 and VT in the study group were higher than those of the control group, and PE-TCO2 was lower than that of the control group (P < 0.05) . After treatment, PEF, FVC, FEV1, VE, SpO2 and VT in the two groups were higher than those before treatment, while PE-TCO2 was lower than that before treatment, respectively (P < 0.05) . There was no significant difference in eosinophil direct count and serum ET-1 and Ⅹ a levels before treatment between the two groups (P > 0.05) ; eosinophil direct count and serum ET-1 and Ⅹ a levels after treatment in the study group were lower than those in the control group (P < 0.05) . The direct eosinophil count and serum ET-1 and Ⅹ a levels in the two groups after treatment were lower than those before treatment, respectively (P < 0.05) . There was no significant difference in ADL scale score and mMRC score between the two groups before treatment (P > 0.05) ; the ADL scale score of the study group was higher than that of the control group，and the mMRC score was lower than that of the control group after treatment (P < 0.05) . ADL scale score of the two groups after treatment was higher than that before treatment, and mMRC score was lower than that before treatment (P < 0.05) . There was no statistical significant difference of incidence of adverse reactions between the two groups (P > 0.05) . Conclusion　Aerosol inhalation of glucocorticoid combined with terbutaline has definite clinical efficacy in the treatment of patients with acute exacerbation of COPD. It can effectively improve the pulmonary function and dyspnea, promote the ADL, and reduce the risk of acute exacerbation, with high safety.

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