目的 探讨慢性阻塞性肺疾病(COPD)并发低氧血症患者抢救中使用小剂量肾上腺素及布地奈德的价值。方法 纳入50例COPD并发低氧血症患者研究(2018年4月—2021年4月),按双盲法分为对照组(n=25,采用布地奈德雾化吸入治疗)、观察组(n=25,在对照组基础上采用肾上腺素治疗),统计2组抢救成功率、临床指标、预后效果。结果 (1)抢救成功率:观察组(96.00%)高于对照组(76.00%),组间对比P<0.05。(2)临床指标:观察组PaCO₂(43.29±4.92 mmHg)低于对照组,PaO₂(86.77±8.25 mmHg)、SpO₂(92.14±2.82%)、pH(7.43±0.12)、FVC(2.41±0.28 L)、FEV1(1.72±0.72 L)、FEV1/FVC(70.95±8.22%)高于对照组,组间对比P<0.05。(3)预后效果:观察组气喘(3.22±1.08 d)、哮鸣音(5.21±1.11 d)消失时间及住院时间(9.61±2.24 d)短于对照组,组间对比P<0.05。结论 小剂量肾上腺素联合布地奈德在COPD并发低氧血症治疗中效果确切,可提高抢救成功率,亦可改善其肺功能及血气指标,值得临床参考。

Objective To explore the value of low dose epinephrine and budesonide aerosol inhalation in the rescue of patients with chronic obstructive pulmonary disease(COPD) complicated with hypoxemia. Methods Fifty patients with COPD complicated with hypoxemia(April 2018 to April 2021)were enrolled and divided into control group(n=25,treated with budesonide aerosol inhalation)and observation group(n=25,treated with epinephrine additionally)according to double-blind method.The rescue success rate,clinical indicators and prognosis of the two groups were statistically analyzed. Results (1)The success rate of rescue of the observation group(96.00%)was higher than that of the control group(76.00%,P<0.05). (2)Clinical indicators:PaCO₂(43.29 1±4.92 mmHg)in the observation group was lower than that of the control group,PaO₂(86.774±8.25 mmHg), SpO₂(92.14±2.82%), pH(7.43±0.12), FVC(2.41±0.28 L), FEV1 (1.72±0.72 L), FEV1/FVC (70.95±8.22%)were higher than that in the control group(P<0.05). (3)Prognosis effect:asthma duration in the observation group(3.22±1.08 d),wheezing disappeared time(5.211±1.11 d)and hospitalization time(9.611±2.24 d)were shorter than that of the control group(P<0.05). Conclusions Low dose epinephrine combined with budesonide in the treatment of COPD complicated with hypoxemia has definite effect, which can improve the success rate of rescue,also improve lung function and blood gas index. It is worthy of clinical reference.

目的 探究雾化吸入布地奈德对急性支气管炎患者疗效及相关指标的影响。方法 选取2016年7月—2018年6月在我院接受治疗的120例急性支气管炎患者作为研究对象,随机分为两组：常规组（60例）和综合组（60例）。常规组实施常规治疗,综合组在常规治疗基础上实施雾化吸入布地奈德治疗,比较两组的整体治疗效果。结果 综合组的治疗总有效率为95.0%,常规组的治疗总有效率为83.3%,综合组要高于常规组,差异有统计学意义（P<0.05）;在PEF、FVC、FEV1等肺功能指标的比较中,综合组和常规组治疗前不存在差异（P>0.05）,治疗后综合组要高于常规组,差异有统计学意义（P<0.05）。结论 急性支气管炎患者实施雾化吸入布地奈德治疗,疗效显著,有利于改善肺功能。

目的 探讨布地奈德联合特布他林对中度哮喘患儿血清变态反应及Th相关指标的影响。方法 选择本院2016年3月—2017年4月收治的中度哮喘患儿100例,将其随机分为2组,各50例。对照组采用布地奈德雾化吸入治疗,观察组采用布地奈德联合特布他林雾化吸入治疗,比较两组临床疗效、血清变态反应与Th相关指标、药物不良反应。结果 1周后,观察组治疗总有效率较对照组高,MCP-1、IgE、IL-10及IL-6水平均较对照组低,差异具有统计学意义(P＜0.05);观察组药物不良反应率与对照组相比,差异无统计学意义(P＞0.05)。结论 布地奈德联合特布他林可提高中度哮喘患儿临床疗效,减轻血清变态反应,改善Th相关指标,且用药安全性较高。

目的 本研究通过检测吸入布地奈德治疗支气管哮喘患儿前、后气道重塑、肺功能及外周血TGF-β浓度的变化,探讨布地奈德在哮喘患儿气道重塑早期干预的作用。方法 将2013年1月—2014年10月在我院确诊为支气管哮喘患儿18例,给予规律吸入布地奈德治疗6个月,分别于治疗前、后检测肺功能、外周血TGF-β浓度以及通过高分辨CT(HRCT)测量支气管管壁厚度(T)并计算管壁面积(WA)、支气管管壁厚度与气管外径之比(WT%)、气道壁横截面面积占气道总截面积的的百分比(WA%)。结果 吸入布地奈德治疗治疗6个月后,哮喘患儿WT%、WA%、肺功能以及TGF-β浓度均明显改善,与治疗前比较差异有统计学意义(P<0.05)。结论 规律吸入布地奈德治疗能减轻支气管哮喘患儿早期气道重塑,改善肺功能,可能通过下调细胞因子TGF-β的表达有关。

Objective We detected the changes of Airway remodeling,lung function and peripheral blood concentrations of TGF-β in asthmatic children before and after inhaled budesonide, and explored the role of budesonide in airway remodeling before early intervention in asthmatic children. Methods 32 cases of children were diagnosed asthma in our hospital,and given treatment of inhaled budesonide for 6 months, and to detect lung function,pheral blood TGF-β concentration as well as measuring the bronchial wall thickness (T) and calculate the wall area (WA), the outer diameter of the trachea and bronchial wall thickness ratio (WT%), the cross-sectional area of the airway wall accounted for airway percentage (WA%) of the total cross-sectional area by high-resolution CT (HRCT) before and after treatment. Results After treatment with inhaled budesonide in six months, the asthma WT%, WA%, lung function, and TGF-β concentrations were significantly improved, the differences compared with that before treatment were statistically significant(P<0.05). Conclusion The treatment of inhaled budesonide can alleviate asthmatic airway remodeling in early, improve lung function,possibly related to down the expression TGF-β.