Comparison of the efficacy and safety of different schemes of methylprednisolone sodium succinate in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease / 中国基层医药

ABSTRACT

Objective To investigate the efficacy and safety of different schemes of methylprednisolone sodium succinate in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods A hundred patients with AECOPD were selected and divided into the control group and the observation group by random number table ,with 50 cases in each group .The control group received intravenous injec-tion of methylprednisolone sodium succinate ,40mg/d,the treatment course was 15d.The observation group received intravenous injection of methylprednisolone sodium succinate ,40 mg/d,the treatment course was 5d.The lung function indicators(RV/TLC,FEV1),blood gas indicators (PaCO2,PaO2,PaO2/FiO2),quality of life index(QLI) score and incidence of adverse reactions were detected and compared between the two groups before and after treatment .Results Compared with before treatment,the RV/TLC of the observation group[(44.2 ±7.4)% vs.(56.7 ±11.1)%]and control group[(43.2 ±7.1)%vs.(55.2 ±10.2)%]after treatment decreased significantly ,the FEV1 of the observa-tion group and control group [(69.7 ±8.7)L vs.(52.4 ±11.6)L,(67.2 ±8.1)L vs.(54.8 ±11.5)L]significantly increased,the differences were statistically significant (t=3.656,3.985,3.364,3.875,all P<0.05),but the differ-ences between the two groups were not statistically significant (t=2.869,1.969,all P>0.05).Compared with before treatment,the PaCO2 of the observation group and control group [(35.7 ±4.5) mmHg vs.(49.6 ±5.2) mmHg,(36.2 ±5.4) mmHg vs.(48.6 ±5.2) mmHg] decreased significantly,and the PaO2 [(84.9 ±13.2) mmHg vs .(50.2 ±4.6)mmHg,(81.1 ±12.3)mmHg vs.(49.6 ±4.9)mmHg]and PaO2/FiO2[(222.5 ±30.7)mmHg vs .(119.3 ±14.6)mmHg,(217.4 ±25.6)mmHg vs.(117.2 ±15.5)mmHg]increased significantly,the differences were statistically significant (t =4.656,3.876,4.985,4.364,3.989,4.875,all P <0.05),but the differences between the two groups were not statistically significant (t=2.526,1.234,1.986,all P>0.05).After treatment,the improvement degree of QLI in the observation group was significantly better than that in the control group [(8.7 ± 2.2)points vs.(7.1 ±1.9)points],the difference was statistically significant (t=4.675,P<0.05).In the observa-tion group,there were 1 case of gastrointestinal discomfort ,2 cases of elevated blood sugar ,and in the control group , there were 4 cases of gastrointestinal discomfort ,2 cases of elevated blood sugar , and 2 cases of hypokalemia .The incidence rate of adverse reactions in the observation group was significantly lower than that in the control group (6.0%vs.20.0%),the difference was statistically significant (χ2 =4.332,P<0.05).Conclusion The short -term methylprednisolone in the treatment of elderly patients with AECOPD has similar effect with conventional dose , but it has minor adverse reactions ,and can improve the quality of life of patients .