Clinical Study Of Different Courses Of Systemic Glucocorticoid In The Treatment Of AECOPD

Objective:To observe and compare the clinical efficacy,adverse reactions and short-term prognosis of patients with acute exacerbation of chronic obstructive pulmonary diseases?AECOPD?treated with methylprednisolone for 5 days and 10days respectively,and to explore the ideal systemic glucocorticoid treatment course for patients with AECOPD.Methods:A total of 84 AECOPD patients admitted to the department of respiratory medicine of the first affiliated hospital of Yangtze university from July 2017 to September 2018 were collected and randomly divided into two groups,with 42patients in each group.The gender,age,smoking history,duration of chronic obstructive pulmonary disease?COPD?,frequency of acute exacerbation of COPD in the previous year and pulmonary function grading of all patients were recorded,and archives were established.Before treatment,all patients were evaluated by using the modified British Medical Research Council?mMRC?questionnaire and the Chinese version of COPD Assessment Test?CAT?questionnaire,and serum c-reactive protein?CRP?were detected,and fractional exhaled nitric oxide?FeNO?,pulmonary function such as forced expiratory volume in one second?FEV_l?,FEV₁%predicted,ratio of FEVl to force vital capacity?FVC?,blood gas analysis such as partial pressure of oxygen?PaO₂?,partial pressure of carbon dioxide?PaCO₂?and arterial oxygen saturation?SaO₂?were estimated,record the results.After admission,oxygen therapy,anti-infection and aerosol inhalation bronchodilators were given according to the guidelines.On the basis of conventional treatment,patients in the two groups were treated with methylprednisolone for 5 days and 10 days respectively,that is,they were divided into the 5-day treatment group and the 10-day treatment group.During treatment,adverse drug reactions of all patients were closely observed,and the above assessment and test were repeated after treatment.Patients in both groups were followed up for 6 months,and acute exacerbation occurred again within 6 months was observed and recorded.Finally,the observation indexes before and after treatment were compared between the two groups.Results:During treatment and follow-up,two patients in the 5-day treatment group and the 10-day treatment group withdrew from the study due to the withdrawal criteria,and finally 80 patients completed the entire study,40 patients in each group.1.The mMRC and CAT questionnaire scores of the two groups after treatment were lower than those before treatment,with statistically significant difference?P<0.01?.MMRC and CAT questionnaire scores of patients in the two groups after treatment were compared,and the difference was not statistically significant?P>0.05?.2.The CRP of the two groups after treatment was lower than that before treatment,and the difference was statistically significant?P<0.01?.There was no significant difference in CRP between the two groups after treatment?P>0.05?.3.FeNO of the two groups after treatment was lower than that before treatment,with statistically significant difference?P<0.01?.There was no significant difference in FeNO after treatment between the two groups?P>0.05?.4.Pulmonary function after treatment showed that FEV1,FEV1%predicted and FEV₁/FVC%of patients in the two groups were higher than before treatment,with statistically significant difference?P<0.01?.After treatment,FEV1,FEV1%predicted and FEV₁/FVC%were compared between the two groups,and the differences were not statistically significant?P>0.05?.5.The blood gas analysis of the two groups of patients after treatment showed that both PaO₂ and SaO₂ were higher than that before treatment,and both PaCO₂ were lower than that before treatment,with statistically significant differences?P<0.01?.After treatment,PaO₂,PaCO₂ and SaO₂ were compared between the two groups,and the differences were not statistically significant?P>0.05?.6.There was no statistically significant difference in the total incidence of adverse reactions between the two groups during treatment?P>0.05?.7.During the follow-up for 6 months,there was no significant difference in the incidence of recurrent acute exacerbation between the two groups?P>0.05?.Conclusion:1.AECOPD patients can significantly alleviate clinical symptoms,improve quality of life,reduce inflammatory reaction,improve pulmonary function,improve PaO₂ and reduce PaCO₂ after 5 days and 10 days of treatment with methylprednisone;However,the extension of treatment did not further improve the patient's condition.2.AECOPD patients received 5 days and 10 days of treatment with methylprednisone,all of which had a certain degree of glucocorticoid adverse reactions,such as elevated blood glucose,stomach discomfort and insomnia,but the course of treatment did not significantly increase the occurrence of adverse reactions.3.AECOPD patients treated with 5 and 10 days courses of methylprednisolone showed no significant difference in short-term prognosis.4.It is recommended that AECOPD patients receive systemic glucocorticoid therapy with a 5-day course of treatment.