雾化吸入布地奈德治疗重度慢性阻塞性肺疾病急性加重中的作用

雾化吸入布地奈德治疗重度慢性阻塞性肺疾病急性加重中的作用 雾化吸入布地奈德治疗重度慢性阻塞性肺 疾病急性加重中的作用 [?????B??]1002-0179(2008)03-0519-02 ???B?S???1?X?q?????????????v NebulizedBudesonideintheTreatment ?4???v???????C?v?????I?????P ofAcuteExacerbationsofChronicObstructivePulmonaryDisease ?????a,?????? 3 ,?2??,?????m LIYan-wu,XUZhi-bo,BAOYong,etal. (?b???]?L?(???u?4??,?????b??X?610031) (TheThirdPeoplefnsHospitalofChengduCity,ChengduSichuan610031,China) X?X?????:????:?????1?X?q?????B???????????v?4???v???????C?v?????m???2???.?????P???FX]????:?(???? ??COPD?C?v?????m???2150?????;?-3??,?1?X?q?????????1?X?q?????B??2mg???B?S??,??8h1?A;???0 ?Z???;?????????????Z???;??????40mg???(????,???y1?A;???????5???P?????????P???fX]?????m?;48hX[7 dX]????:?1?X?q????X[?Z???;????????????????????,FEV1X[PaO2X[PaCO2?:???F???(?<???v???](P<0105); ?1?X?q????X[?Z???;?????????x???0???7?7?:???)?????F(P>0105),?#?1?X?q?????????P?N?<?????Z???;???? ????(P<0105)X]????:???B?1?X?q???????????(?q?:??AECOPD???z?j????,???q?N???0?Z???;?????????F, ?????????P?e,?????;???P???f?????????????(??X] ???Y??:???v?4???v??????;?1?X?q????????;?S??;?Z???;?????? [?I???-????]R563X?X?X?[???Y?7???[]A X?X?Abstract:Objective:Toevaluatetheclinicalefficacyofnebulizedbudesonide(NB)inacuteexacerbationsofchronicob2 structivepulmonarydisease(COPD).Methods:Patientswererandomlydividedintothreegroups.TheNSgroupreceivednebu2 lizedbudesonidebyexacerbationwith2mgevery8h.Theprednisolonegroupwastreatedwith40mgbyintravenouseveryday.The placebowasofferedcommontreatmentandnottreatedwithadrenocorticalhormones.Allgroupswereobservedfor48hand7d. Results:BothbudesonideandprednisoloneimprovedinFEV1X[PaO2andPaCO2wwhencomparedwithplacebo(P<0105).The differenceinFEV1X[PaO2X[PaCO2betweenbudesonideandprednisolonewasnotsignificant(P> 0105).Theoccurrenceofseri2 ousadverseintheNSgroupwerelowerthanthePSgroup(P<0105).Conclusion:Bothbudesonideand prednisoloneimproved obstruentairflowinCOPDpatientsNebulizedbudesonidemaybeanalternativetointravenouspredniso loneinthetreatmentof nonacidoticexacerbationsofCOPDwithloweradverseevents. Keywords:acuteexacerbationofchronicobstructivepulmonarydisease;budesonidesuspension;inhal ation;prednisolone (Receiveddate:2007-12-10) ??11( ??)?H/?????)(??)FEV1%PaO2mmHgPaCO2mmHg NS??6315??81732/181019??8153912??8175011??13194916??1213 PS??6412??61434/161110??5153715??7154918??12145019??1110 ??????6317??91932/181016??6193711??7115211??10195011??1119 P>0105>0105>0105>0105>0105>0105 ??21FEV1%X[FVC%X[PaO2X[PaCO2???? ??????D2D7 FEV1%NS?? PS?? ?????? 3912??817 3715??715 3711??711 4313??12133# 3911??14193 3715??1312 4610??13193# 4416??14113 3814??1412 PaO2mmHgNS?? PS?? ?????? 5011??1319 4918??1214 5211??1019 5715??13163# 5913??1019 3 5315??1211 6112??14133# 6111??1219 3 5612??1214 PaCO2mmHgNS?? PS?? ?????? 4916??1213 5019??1110 5011??1119 4611??9193# 4814??919 3 4917??1114 4019??10153# 4117??919 3 4915??918 ??:?N??????????:3P<0105;?NPS??????:#P>0105 ??31NS??X[PS???N???????????P?????? ???????R???????5?]?????%?R???????p NS??501(2%)2(4%)1(2%)1(2%) PS??508(16%)3 6(12%)3 4(8%)3 1(2%) ??:?NNS??????:3P<0105 X????2?????????a(6),??,?? ???b????,?4???4?9,?4??????X] X?3( COPD)?w???? ???vX[?b???v????X]COPD???2?????? ?C?v?????A????1??4?A [1] ,?????????2 ?????????BX[???????)??X[?????????m ?4?P???)??,?????C?v?????m???????? ?S????X]2006??COPD?Z?????1?A?? (GOLD???q)?7??COPD?C?v?????m?? ?2???m???????P?????P???f???:?????? ??,?y?????5????,???u?5????,???? ?m?4?P??,?????????P?????z???? (FEV1)<50%?????F???????5?C?v???? ??COPD???2???????P [2] X]?#???f???5 ?????????????????P???X???p,?z?.?? COPD?t?;?[????,?S?9??????????, ????????,?w?????P???????f?i?????? ??????,???3?????m?4?P???)??,?4?? ?:?P???? [3] X]????,?.???8?????????? ???????????????P???f??????????X] ???B?1?X?q?????P???.?????(?j?? ????X]???????4?v??,?????v??,?;?? ???S???v???f?P???w?z????????COPD ?g???m??????X]?p?3,?????B???(?u?? ?z?????????P?w?z????????COPD?C?v ?????m?????P [4??9] X]?:???z?????????? ???(?????5?3,?????z???I???P???B?1 ?X?q???M???1???;????1??8mgX]?L?z ???????????????P???f???B?S???????P ????COPD?C?v?????m?????q???????vX] 1X??????????? 111X??????(??:?(??2005??5?9?? ??5?9?????u????OD?C?v???? ?m???25??,???I?H??,??5??, ???G????6318??813??,????50??X]?? ?(?7??:(1)?O?9COPD?C?v?????m?? ???7?? [10] ,(2)1s?P?????4??(FEV1) <50%?3c?30%,(3)?R?z?-???;???? ?I??,(4)???????2X]?????7??:(1) ?????;?w?z??????,(2)?9???<?;???? ?v????,(3)???m???P?????P???f?B 3?y?????????P???????P???f,() ????????,?C?????>?????????(???f?? ?P??????,(5)????????,?????????5 ???k?????e???C??????,(6)?9?????S ?????????;???t?zX] 112X??????N????:???P????SEN2 SORMEDICS6200???????????????????W ??,?1?X?q?????B??????(?#???5:?? ???W???l,AstraZeneca?????m??)2mg ???B?S??(???PPARIBOYN???s???y ???B?S???;,?????????(???????m??) ,???0?P?Z???F???C??????(?#?? ?5?Z?;??,?????????m??)?? ?(????qX] 13X??????????-?????;?-???B?1 915?????4??2008,23(3)X?CN51-1356/R :197- : 2007CP 10982 04tid :40mg d 1:: (NS)??X[???0?Z???;?????? (PS)??????????3??,?-???(???)???q ?P??,NS???????1?X?q?????B??2mg ???B?S??,???y?(?A;PS???????Z???; ??????40mg/?y;???????5???P?????? ???P???fX]?????m?;7?y,?m???( GOLD???q?????w?z?????f?MX[???m?fX[ ??????X[?v???k?S??????,?#?5?????P ?????????????P???fX]?R?(?????-?,?P ???(??X[?????????N48hX[7d???????( ?R?z?-???????w?z?????f?M???P???N?? ?????W??X]???(?R?z?-???2???R?v?-?? (PaO2)X[???(???v?B???-??(PaCO2), ???????7?7???????P?????z???? (FEV1)?????BX]?????m???????????v ????,?????????P???f???????????P, ?2???????m???R?(?.???????????]?SX] ????????????????????????t???????? ???-??X]???????L?????4???O?-?????t ????,?p???0???5?????????C?????q, ?????????(?????????????3?e??X] 2X????? 211X?150?????2?????L?????-??,???? ?????????????0?-,P>0105X]?(???? ?????????P????X[???)X[FEV1%???R?z ?-???????????(?????v(??1)X] 212X??N?5???P???f????,NS????PS ???????(?R?z?????????7?7???5????X] PS????NS???????(?v?-??(PaO2)?? ???????P?????z????(FEV1)?G?<???? ?p,?x???????NFEV1??PaO2?G?(?N?< ?:??(P<0105),?x?????0?7?7?P?0?? ???????:???)?????F(P>0105),Pa2 CO2?F?:???)???????FX]?1?X?q?????? ??2mg/?AX[???y?(?A?S???????q?N?? ?0?Z???;??????40mg/?y????,?4???? ???????7?7FEV1%X[PaO2X[PaCO2?F?P ???)?0?????N?????????????]?(?<???v (??2)X] 213X????(???0???P???f???5???????t ???S?????f??(??3)X] 3X????? COPD?C?v?????m???????????4?? ?2???w?z?????f?MX[???m???k????(?( ?m????)?????????P???P???f?kX]?P COPD?C?v?????m???2?I?????????z?? ???????I?v??????????,?U?????????? ???????P?.???G??,?2?????x???????? 1?(TNF-1?),???(??B4(LTB4)???? ???f8(IL-8)?k,???P???f?????N?? ??COPD?C?v?????m???2?????z?????? ???I?v??????????TNF-1?X[LTB4X[IL -8?k???????P?.???)?? [2] X]???- COPD?C?v???????2???P?z???????v?? ?????v????????,?t???w?z???????4 ??,?????PCOPD?C?v?????m?z?????? ?????v??????????????COPD?g???m?? ??30?5 [11] ,???B,?????v???????g?? ??????(ECP)???,?????N?<???? COPD?g???mX]?PCOPD?C?v?????m?8 ???????????)?????????-????T?????? ?????-?????4?B????(RANTES)?<?? ?8?1,?zRANTES?N???4???????v???? ?????????????b?????? [12] X]???8???? ?????????????P???f?P????COPD?C?v ?????I?????PX]?L???z???<?;,?N?5?? ?P???f????,NS????PS???????(?R?z ?????????7?7???5????,???N???f???? ?(?qX]?NM?k [,,] ???z???????? ?FX]?t???????4???z?????N,???????P ?????P???f??????OD?C?v?????m?? ?2??????,?????????????5,?:?????v ?R??,???????m???5?????????U?C???? ??,?y???????????k [13,14] X]?p?3,?? ?P???????P???f???5???????w?<?3?i?? ??X]Niewoehner?k [14] ???J,AECOPD?? ?2???????P???F????30mg,2???N?R ???G??X[???>???????k?5?????????<?? ??????????X]???????v???P???P???f?P ??COPD?C?v?????m??????????/?p?? ???????????????????????w???(?C?? COPD???2?????w?3?????(?????????? ?[????X]?????????)?I?????.?(?t???? ????????,?????????S???m???P?????v ???P???f [15-19] X]???P???f???5?????? ?N???2?R???P???w???M???(??X]?w???M ???w???P???????P???f?????P?I?????? ???f [8,20,21] X]?????????????P?????v?? ?P???f???5???[?????P???H?(??,???m ???5???P?????2???m???P???????????? ???????N?<????X]???????P???f?d???? ?C?????????N?<???????2?m???P?????? ???????w??X]????,?????v???P???P?? ?f?P??COPD?C?v?????m???????m???? ??/?p???????????5??X] ???P???f?????B?S???????U???P?? ?u,?????5???????R???????3???????P ????????,???????q???3?5???????u, ?S???N???-???S?p??????,?#???A???( 85??90%???????????e????,?R???b?? ???c?????4?v????,????????????X]?L ?????????<?;,?1?X?q????????2mg/ ?AX[???y?(?A?S???????q?N???0?Z???; ??????40mg/?y????,?4???????????7 ?7FEV1%X[PaO2X[PaCO2?F?P???)?0?? ?????????<???v???]X]?z?N???????? ??,FEV1X[PaO2X[PaCO2?:???F???(?< ???v???]X]???N???B?S???1?X?q?????? ???????;???P???f?????????????(??X] ???(???0???P???f???5???????t???S?? ???f??,?L?????(?????2???????????C ??????,???5?????????????u,???m?? ?P???(?I??????X]????:???B???P???f ???????;????COPD???2?C?v?????m?? ?????????????(??X] ?L?????????????B?S???N???????P ???P???f?P???????I???v????COPD?C ?v?????m???(???F???q,?3?P???2?C?v ?????m??,???B?S???M?U???????u???5 ???????3?o???????v????X] 4X????1???Y: [1]MiriciA,MeralM,AkgunM.Comparisonof theefficacyofnebulisedbudesonidewith parenteralcorticosteroidsinthetreatmentof acuteexacerbationsofchronicobstructive pulmonarydisease[J].ClinDrugInvest, 2003,23(1):55-62. 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