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目的对比观察不同剂量糖皮质激素治疗重症慢性阻塞性肺疾病(COPD)急性加重期患者的疗效及安全性。方法将因COPD急性加重而入住ICU的135例患者随机分为低剂量组68例和高剂量组67例,分别给予甲基强的松龙40mg/d和80mg/d,静脉滴注,2组疗程均为5d,观察2组患者肺功能、动脉血气分析指标改善情况及不良反应发生情况,比较2组患者临床疗效及28d病死率。结果治疗后2组患者肺功能、动脉血气分析指标均显著改善(P<0.05),2组间比较差异无统计学意义(P>0.05);低剂量组不良反应发生率低于高剂量组(P<0.05);2组总有效率和28d病死率比较差异无统计学意义(P>0.05)。结论与低剂量方案相比,高剂量的治疗方案并未表现出优势,且增加了不良反应。应鼓励对入住ICU的重症COPD急性加重期患者实施低剂量的糖皮质激素策略,而此类患者的最佳糖皮质激素剂量仍有待相关临床试验加以确定。
Objective To compare the efficacy and safety of different doses of glucocorticoid in the treatment of patients with severe chronic obstructive pulmonary disease (COPD) in acute exacerbation. Methods A total of 135 patients admitted to the ICU due to acute exacerbation of COPD were randomly divided into low dose group (68 cases) and high dose group (67 cases), and were given methylprednisolone 40mg / d and 80mg / d, The course of treatment was 5 days. The pulmonary function, the improvement of arterial blood gas analysis and the incidence of adverse reactions in the two groups were observed. The clinical efficacy and 28-day mortality were compared between the two groups. Results After treatment, the indexes of pulmonary function and arterial blood gas analysis were significantly improved in both groups (P <0.05), but there was no significant difference between the two groups (P> 0.05). The incidence of adverse reactions in the low dose group was lower than that in the high dose group P <0.05). There was no significant difference in the total effective rate between the two groups and the 28d mortality rate (P> 0.05). Conclusion Compared with the low-dose regimen, high-dose regimen did not show any advantages and increased adverse reactions. Low-dose glucocorticoid strategies should be encouraged in patients admitted to ICU with severe exacerbation of COPD and the optimal glucocorticoid dose for such patients remains to be determined by relevant clinical trials.