目的 探索比较布地奈德联合沙丁胺醇与丙酸倍氯米松联合沙丁胺醇治疗重症肺炎患者的疗效.方法 选取2020年1月至2022年2月郑州大学第五附属医院收治的重症肺炎患者195例为研究对象,按照随机数字表法分为研究1组、研究2组与对照组,各65例.对照组接受沙丁胺醇治疗,研究1组接受布地奈德联合沙丁胺醇治疗,研究2组接受丙酸倍氯米松联合沙丁胺醇治疗,均治疗2疗程,7 d为1疗程.比较各组疗效、临床疗效指标、心功能与血气指标、呼吸力学指标、血清炎症指标、不良反应的差异.结果 等级资料秩和检验结果显示,各组治疗2疗程后疗效比较差异存在统计学意义(Z=11.275,P＜0.05),且研究1组、研究2组治疗2疗程后总有效率均高于对照组(P＜0.05).各组病死率比较差异无统计学意义(P＞0.05),但研究1组、研究2组退烧时长、机械通气时间、ICU住院时间、肺损伤率均低于对照组,成功撤机率均高于对照组(P＜0.05).各组治疗 2 疗程后左室射血分数(left ventricular ejection fraction,LVEF)、动脉血氧分压(partial pressure of oxygen in arterial blood,PaO2)、经皮血氧饱和度或末梢血氧饱和度(peripheral capillary oxygen saturation,SpO2)与治疗前比较均升高,动脉血二氧化碳分压(partial pressure of carbon dioxide in arterial blood,PaCO2)、舒张期室间隔厚度(di-astolic ventricular septal thickness,LVST)与治疗前比较均降低(P＜0.05);且研究1组、研究2组治疗2疗程后上述心功能与血气指标均优于对照组(P＜0.05).各组治疗2疗程后RAW、Cdyn与治疗前比较均升高,PEEP、Pplat与治疗前比较均降低(P＜0.05);且研究1组、研究2组治疗2疗程后上述呼吸力学指标均优于对照组(P＜0.05).各组治疗2疗程后CRP、IL-8、TGF-β1、IGF-Ⅱ与治疗前比较均降低(P＜0.05);且研究1组、研究2组治疗2疗程后CRP、IL-8、TGF-β1、IGF-Ⅱ均低于对照组(P＜0.05).各组恶心呕吐发生率、头晕发生率、发热发生率、肌痛发生率、心率加快发生率、皮疹发生率、腹泻发生率比较差异无统计学意义(P＞0.05),但研究1组、研究2组不良反应总发生率均低于对照组(P＜0.05).但研究1组、研究2组治疗2疗程后总有效率、临床疗效指标、心功能与血气指标、呼吸力学指标、血清炎症指标、不良反应比较差异无统计学意义(P＞0.05).结论 布地奈德、丙酸倍氯米松联合沙丁胺醇治疗重症肺炎均具有较好疗效,可有效改善患者心功能、血气指标与呼吸力学指标,缓解炎症反应,且安全性较好,两者治疗效果相当.
Comparison of efficacy of budesonide and beclomethasone propionate combined with salbutamol in patients with severe pneumonia
Objective Exploring the efficacy of comparing budesonide combined with salbutamol with beclomethasone propionate combined with salbutamol in the treatment of patients with severe pneumonia.Methods Totally 195 severe pneumonia patients admitted to the Fifth Affiliated Hospital of Zhengzhou University from January 2020 to February 2022 were selected as the study subjects,which were divided into study group 1,study group 2 and control group,with 65 ca-ses each.The control group received treatment with salbutamol,study group 1 received treatment with budesonide com-bined with salbutamol,and study group 2 received treatment with beclomethasone propionate combined with salbutamol,both receiving 2 courses of treatment,with 7 days being 1 course.Compare the differences in therapeutic efficacy,clini-cal efficacy indicators,heart function and blood gas indicators,respiratory mechanics indicators,serum inflammation in-dicators,and adverse reactions among different groups.Results The results of rank sum test of rank data showed that the difference after 2 courses(Z=11.275,P＜0.05),and the total response rate of group 1 and group 2 was higher than that of the control group(P＜0.05).But the fever time,mechanical ventilation time,ICU stay and lung injury rate in study 1 and study 2 were lower than that of the control group,and the successful withdrawal rate was higher than that of the control group(P＜0.05).LVEF,PaO2,and SpO2 were higher before treatment,and LVST,PaCO2 and treat-ment decreased after treatment 2(P＜0.05),and the cardiac function and blood gas indexes in group 1 and group 2 were better than those in the control group(P＜0.05).RAW,Cdyn increased after the treatment 2,and decreased be-fore treatment in each group(P＜0.05);and the respiratory mechanics parameters in study group 1 and study group 2 were better than those in the control group after treatment 2(P＜0.05).CRP,IL-8,TGF-β1,IGF-Ⅱ were lower than those before treatment(P＜0.05);and CRP,IL-8,TGF-β1,and IGF-Ⅱ in study arm 1 and arm 2 were low-er than those in the control group(P＜0.05).The incidence of nausea and vomiting,dizziness,fever,myalgia,heart rate,rash,and diarrhea were not significant(P＞0.05),but the total incidence of adverse reactions in study group 1 and study group 2 was lower than that in the control group(P＜0.05).However,there was no significant difference be-tween the total response rate,clinical efficacy,cardiac function,respiratory mechanics,serum inflammation,and ad-verse effects between study group 1 and study group 2(P＞0.05).Conclusion Budesonide,becclomethasone propio-nate combined with salbutamol to treat severe pneumonia have good efficacy,which can effectively improve the cardiac function,blood gas index and respiratory mechanical index of patients,and relieve inflammatory response,and the good safety,but the treatment effect is comparable.
Severe pneumoniaBudesonideBeclomethasone propionateSalbutamolEfficacy
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