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目的探讨呼出气一氧化氮(Fe NO)测定对老年慢性阻塞性肺疾病急性发作期(AECOPD)用药选择中的指导作用。方法对我院在2013年3月至2014年3月收治的76例老年AECOPD患者进行Fe NO检测及症状评估,以27 ppb为Fe NO“切点”值,将76例患者分为低Fe NO组和高Fe NO组;高Fe NO组在低Fe NO组治疗基础上,加用糖皮质激素治疗,并分析不同治疗组的疗效。结果低Fe NO组患者31例(40.8%),平均Fe NO为(23.7±7.4)ppb;高Fe NO组患者45例(59.2%),平均Fe NO为(38.5±10.2)ppb。症状评估:低Fe NO组中3级12例,4级19例;高Fe NO组中3级14例,4级31例。两组之间症状轻重比较,差异无统计学意义(P>0.05)。两组疗效比较,差异无统计学意义(P>0.05)。高Fe NO组治疗后Fe NO检测值显著低于治疗前(P<0.01)。结论 Fe NO的高低不能作为老年AECOPD症状轻重的指标,但可指导治疗方案的选择,部分低Fe NO者可不加用糖皮质激素治疗,但还需进一步研究。
Objective To investigate the guiding role of exhaled nitric oxide (NO) determination in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Sixty-seven elderly patients with AECOPD admitted to our hospital from March 2013 to March 2014 were evaluated for Fe NO and their symptoms were evaluated. 27 patients were divided into low NO Fe NO group and high Fe NO group. The high Fe NO group was treated with glucocorticoid on the basis of low Fe NO group, and the curative effect of different treatment groups was analyzed. Results The average Fe NO was (23.7 ± 7.4) ppb in 31 patients (40.8%) with low Fe NO group and 45 (59.2%) in the high Fe NO group. The mean Fe NO was (38.5 ± 10.2) ppb. Symptom assessment: In the low Fe NO group, there were 12 cases in grade 3 and 19 cases in grade 4, 14 cases in grade 3 and 31 cases in grade 4 in high Fe group. The severity of symptoms between the two groups, the difference was not statistically significant (P> 0.05). There was no significant difference between the two groups (P> 0.05). Fe NO levels in high-Fe group were significantly lower than those before treatment (P <0.01). Conclusion The level of Fe NO can not be used as an indicator of the severity of AECOPD in the elderly, but it can guide the choice of treatment options. Some patients with low Fe NO may not receive glucocorticoid therapy, but further study is needed.