地塞米松联合头孢呋辛钠治疗AECOPD合并肺气肿的疗效分析
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篇名: 地塞米松联合头孢呋辛钠治疗AECOPD合并肺气肿的疗效分析
TITLE:
摘要: 目的:探讨地塞米松联合头孢呋辛钠治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并肺气肿的疗效和安全性。方法:回顾性收集80例AECOPD合并肺气肿患者资料,按照用药不同分为观察组和对照组,每组40例。两组患者入院后均立即卧床休息,并给予营养支持、维持电解质平衡等对症支持治疗,与此同时,对照组患者给予注射用头孢呋辛钠1.5 g加入0.9%氯化钠注射液100 ml 中静脉滴注,bid(若抗感染效果不佳则增加剂量至2.0 g);观察组患者在对照组治疗基础上加用地塞米松磷酸钠注射液5 mg加入0.9%氯化钠注射液20 ml中雾化吸入,bid。两组患者均连续治疗1周。观察两组患者治疗前后肺功能相关指标,包括6 min步行距离(6MWT)、肺活量(FVC)、第1 秒用力呼气容积(FEV1)、FEV1/ FVC、呼气中断流速(MMEF)以及最高呼气流速(PEF)水平;炎症细胞因子水平,包括多形核白细胞(PMN)、白细胞介素(IL)-8、IL-17、超敏C反应蛋白(hs-CRP)和肿瘤坏死因子(TNF)-α水平;气管阻力相关指标,包括呼吸总阻抗(Z5)、共振频率(Fres)和总气管阻力(R5)水平;肝、肾功能指标,包括丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿素氮(BUN)、血肌酐(Scr)和尿肌酐(Ucr)水平。结果:治疗前两组患者肺功能相关指标、炎症细胞因子水平和气管阻力相关指标比较差异均无统计学意义(P>0.05)。治疗后,两组患者肺功能相关指标显著高于同组治疗前,且观察组高于对照组,炎症细胞因子水平和气管阻力相关指标均显著低于同组治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。安全性方面,两组患者治疗前后肝、肾功能指标均在正常范围内。结论:地塞米松联合头孢呋辛钠治疗AECOPD合并肺气肿疗效较好,可明显改善患者的肺功能,降低患者的炎症反应和气管阻力,且安全性较好。
ABSTRACT: OBJECTIVE: To observe the effect and safety of dexamethasone combined with cefuroxime sodium in the treatment of AECOPD (acute exacerbation of chronic obstructive pulmonary disease) complicated with pulmonary emphysema. METHODS: The data of 80 AECOPD patients complicated with pulmonary emphysema was retrospectively analyzed and patients were divided into test group and control group by different administration, 40 cases in each group. All patients rest on bed immediately after admission, then given nutritional support to maintain electrolyte balance and other symptomatic and supportive treatment, based on it, control group received 1.5 g Cefuroxime sodium injection adding into 100 ml 0.9% Sodium chloride solution by intravenous infusion,twice / d (if the anti-infection effect was not good, the dose was increased to 2.0 g). observation group was additionally given dexamethasone Sodium phosphate injection 5 mg adding into 20 ml of 0.9% Sodium chloride solution by inhaling, twice/d. Two groups were treated for 1 week. The pulmonary functions [including 6-minute walk test (6MWT),vital capacity(FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, mid-expiratory flow rate (MMEF), maximum expiratory flow rate (PEF) levels] before and after treatment, inflammatory cytokine levels [including polymorphonuclear leukocytes (PMN),IL-8, IL-17, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF-α)], airway resistance [including the total respiratory impedance (Z5), resonant frequency (Fres), total airway resistance (R5)], liver and kidney function indicators [including alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen (BUN), creatinine (Scr), urea nitrogen(Ucr)] in 2 groups were observed. RESULTS: Before treatment, there were no significant differences in pulmonary functions, inflammatory cytokine levels and airway resistance related indicators in 2 groups(P>0.05). After treatment, pulmonary function related indicators in 2 groups were significantly higher than before, and observation group was higher than control group, inflammatory cytokine levels and airway resistance related indicators were significantly lower than before, and observation group was lower than control group, with statistical significances(P<0.05). In terms of safety, ALT, AST, BUN, Scr, Ucr before and after treatment in 2 groups were all within the normal range. CONCLUSIONS: Dexamethasone combined with cefuroxime sodium has good therapeutic effect on patients AECOPD complicated with emphysema, which can significantly improve the pulmonary functions and reduce airway resistance in patients, with good safety.
期刊: 2016年第27卷第36期
作者: 刘义,黄小权,孙小兵
AUTHORS: LIU Yi,HUANG Xiaoquan,SUN Xiaobing
关键字: 地塞米松;头孢呋辛钠;慢性阻塞性肺疾病急性加重期;肺气肿;疗效;安全性
KEYWORDS: Dexamethasone; Cefuroxime sodium; AECOPD; Pulmonary emphysema; Efficacy; Safety
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