间质性肺病并发重症肺炎患者糖皮质激素冲击治疗的疗效观察

间质性肺病并发重症肺炎患者糖皮质激素冲击治疗的疗效观察尹成伟;李淑芳;张涛;邱振伟
【期刊名称】《疑难病杂志》
【年(卷),期】2016(015)009
【摘要】目的：观察间质性肺病（ ILD）并发重症肺炎患者糖皮质激素冲击治疗
的疗效。

方法收集2011年1月—2015年12月上海中医药大学附属曙光医院综
合ICU收治的68例ILD并发重症肺炎患者，随机分为治疗组（34例）、对照组（34例）。

所有患者均予抗感染、抗纤维化等常规对症治疗；治疗组加用甲强龙40 mg，每8 h 1次静脉滴注，血气及体征改善后甲强龙减量为40 mg，每12 h 1次静脉滴注，每3 d甲强龙减20 mg，维持治疗2周。

比较2组患者临床症状
体征消失时间、CRP评分、动脉血气与乳酸水平变化，以及并发症的发生情况。

结果与对照组比较，治疗组发热、憋喘、肺部啰音及咳嗽等临床症状、体征消失时间均明显缩短（ t ＝12�．67、6．02、8．10、2．21， P均＜0．05）。

治疗后，2组肺容量、弥散量、FVC、FEV、呼吸困难、肺部影像学等项目均有显著改善，而治疗组肺容量、弥散量、FEV、呼吸困难、肺部影像学的改善程度显著优于对照组（ t ＝6．54、6．06、2．54、4．07、3．94， P ＝0．000、0．000、0．013、0．000、0．000）。

治疗后，2组患者各血气分析指标、血乳酸均有不同程度改善，治疗组PaO2、SaO2和血乳酸均优于对照组（t ＝4．87、2．10、2．84，P均＜0．05）。

2组并发症发生率无显著差异（17．6％vs．11．8％，χ2＝0．47， P ＝0．494）。

结论糖皮质激素冲击治疗可快速减轻ILD并发重症肺炎患者的炎性反应，促进症状改善，且不明显增加并发症。

%Objective To explore the effects of glucocorticoid pulse therapy in the treatment of
interstitial lung dis-ease ( ILD) combined with severe pneumonia .Methods Sixty-eight cases of ILD combined with severe pneumonia were ran-domly divided into two groups .Conventional treatment including anti-infection and anti-fibrosis.Control group ( n =34) was not given glucocorticoid , treatment group ( n =34) was given methylprednisolone 40mg/d intravenous infusion for once every 8 hours, then decreased to 40mg/d intravenous infusion for once every 12 hours after the improvement of blood gas and signs , and minus 20 mg methylprednisolone every three days .The total treatment course was 2 weeks.The disappeared time of clini-cal symptoms and signs , CRP score, changes of arterial blood gas , blood lactic acid and complications between two groups were compared.Results Compared with control group , disappeared time of fever , gasping, lung rale and cough in treatment group were significantly shortened ( t =12.67, t =6.02, t =8.10, t =2.21, all P <0.05).After treatment, the lung ca-pacity, dispersion, FVC, FEV, lung imaging, dyspnea in both groups have improved significantly , and lung capacity, disper-sion, FEV, lung imaging, dyspnea in treatment group improved more remarkably than those of control group ( t =6.54, t =6.06, t =2.54, t =4.07, t =3.94,all P <0.05).After treatment, the blood gas indicators and blood lactic acid in both groups were significantly improved than those before treatment , and PaO2 , SaO2 and blood lactic acid in treatment group were improved more remarkably than those in control group ( t =4.87, t =2.10, t =2.84, P
<0.05).There was no significant difference on complications between treatment group and control group( 17.6%vs.11.8%,χ2 =0.47, P
=0.494).Conclu-sion Glucocorticoids pulse therapy can quickly reduce the inflammatory reaction for ILD combined with severe pneumonia , promote the improvement of clinical symptom and stable condition , and does not significantly increased complications .
【总页数】4页(P919-922)
【作者】尹成伟;李淑芳;张涛;邱振伟
【作者单位】200021 上海中医药大学附属曙光医院综合ICU;200021 上海中医药大学附属曙光医院综合ICU;200021 上海中医药大学附属曙光医院综合
ICU;200021 上海中医药大学附属曙光医院综合ICU
【正文语种】中文
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