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目的探讨短期雾化吸入低剂量糖皮质激素在老年慢性阻塞性肺疾病急性加重合并陈旧肺结核治疗中的作用。方法将90例患者随机分为A、B、C 3组,A组采用常规治疗,B组在常规治疗基础上加用低剂量布地奈德雾化吸入治疗,C组在常规治疗基础上加用低剂量布地奈德联合异丙托溴铵、沙丁胺醇雾化吸入治疗。比较治疗前、治疗10d后3组一秒用力呼气容积(forced expiratory volume in one second,FEV_1)占正常预计值百分比(FEV_1%pre)、FEV1/用力肺活量(forced vital capacity,FVC)、血氧分压(partial pressure of oxygen,PaO_2)、二氧化碳分压(arterial carbon dioxide partial pressure,PaCO_2)水平;比较3组患者住院时间以及出院时和随访2个月结核复发情况。结果 3组治疗10d后FEV1%pre、FEV1/FVC、PaO_2、PaCO_2等指标均较治疗前有明显恢复(P<0.01),其中B组各项指标恢复优于A组(P<0.05),C组各项指标恢复优于B组和A组(P<0.05);B组和C组住院时间显著少于A组(P<0.05);3组患者出院时及随访2个月均无肺结核复发。结论在常规治疗的基础上吸入低剂量糖皮质激素治疗可短期内改善AECOPD患者的肺功能和血气分析指标,加用β_2受体激动剂和抗胆碱能药物联合吸入则效果更佳;加用低剂量糖皮质激素雾化吸入治疗或者联合吸入治疗还可缩短患者的住院时间;短期吸入低剂量糖皮质激素可能不会导致合并陈旧肺结核的老年AECOPD患者出现结核复发,但需要多中心、大样本、长时间的研究和随访才能得出较可靠的结果 。
Objective To investigate the role of short-term inhalation of low dose glucocorticoid in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and old tuberculosis. Methods Ninety patients were randomly divided into A, B and C groups. The patients in group A received routine treatment. Group B was treated with low-dose budesonide inhalation on the basis of conventional treatment. Group C was treated with routine treatment Low-dose budesonide combined with ipratropium bromide, salbutamol inhalation therapy. Before treatment, the forced expiratory volume in one second (FEV_1), the percentage of normal predictive value (FEV_1% pre), forced vital capacity (FVC), oxygen saturation Partial pressure of oxygen (PaO_2) and arterial carbon dioxide partial pressure (PaCO_2) were compared between the two groups. The length of hospital stay, tuberculosis recurrence at discharge and 2 months after operation were compared. Results The indexes of FEV1% pre, FEV1 / FVC, PaO_2 and PaCO_2 in the three groups were significantly recovered after treatment for 10 days (P <0.01), and the indexes in group B were better than those in group A (P <0.05) The indexes of group recovery were superior to those of group B and group A (P <0.05). The length of stay in group B and group C was significantly less than that of group A (P <0.05). There was no recurrence of tuberculosis at discharge and at 2 months . CONCLUSIONS: Inhalation of low-dose glucocorticoid therapy on the basis of routine treatment may improve pulmonary function and blood gas analysis index in patients with AECOPD in short term. Combined with β 2 receptor agonist and anticholinergic drugs inhalation is better; Low doses of glucocorticoid inhaled or combined inhaled therapy may also shorten hospital stays; short-term inhaled low-dose glucocorticoid may not cause tuberculosis relapse in elderly patients with AECOPD with stale tuberculosis but require a multicenter, large sample Prolonged research and follow-up lead to more reliable results.