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目的:探讨糖皮质激素在抢救糖尿病合并慢性阻塞性肺疾病急性加重(AECOPD)、肺心病并发II型呼吸衰竭、肺性脑病中的作用及安全性。方法:选择“糖尿病合并慢性阻塞性肺疾病急性加重,肺心病并发II型呼吸衰竭、肺性脑病”病人130例,随机按先后顺序分成两组,对照组(62人):积极采用低流量持续吸氧,静脉使用氨茶碱联合可拉明、洛贝林、甘露醇、速尿进行抢救及常规抗感染等对症治疗,疗程7天。观察组(68人):积极采用持续低流量吸氧、静脉使用氨茶碱联合可拉明、洛贝林、甘露醇、速尿、加用糖皮质激素(琥珀酸氢化可的松)进行抢救,并同时给予胰岛素(诺和林30R)降糖、常规抗感染等综合对症治疗,疗程7天。结果:一周内,观察组(68人)有7人死亡,其他病人都得到不同程度的好转;5例出现尿酮症阳性,血酮体阴性,随机血糖平均在8.6mmol/L。对照组(62人)有12人死亡,8例出现尿酮症阳性,血酮体阴性,随机血糖平均为9.3mmol/L。两组病员血气分析检查除死亡病人以外均有好转。结论:在抢救糖尿病合并慢性阻塞性肺疾病急性加重、肺心病并发II型呼吸衰竭、肺性脑病时糖皮质激素仍是首选,并未出现血糖过高现象,与配合使用胰岛素(诺和林30R)降糖有关,少数病人出现大便隐血弱阳性,与病重应激有关。尿酮体阳性与病员进食差有关。糖皮质激素应用越早越好。由于观察的病员量较少,安全性有待于进一步观察证实。
Objective: To investigate the effect and safety of glucocorticoids in rescue of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), pulmonary heart disease complicated with respiratory failure of type II and pulmonary encephalopathy. Methods: One hundred and thirty patients with acute exacerbation of chronic obstructive pulmonary disease and pulmonary heart disease complicated with type II respiratory failure and pulmonary encephalopathy were randomly divided into two groups according to the sequence: control group (62): active low Continuous oxygen flow, intravenous aminophylline combined with cocaine, lobeline, mannitol, furosemide for emergency treatment and conventional anti-infective symptomatic treatment, treatment of 7 days. Observation group (68 people): active continuous low-flow oxygen inhalation, intravenous aminophylline combined with calamine, lobeline, mannitol, furosemide, plus glucocorticoid (hydrocortisone succinate) for rescue , And given insulin (Novo-Lin 30R) hypoglycemic, conventional anti-infective and other comprehensive symptomatic treatment, treatment of 7 days. Results: In one week, 7 patients died in the observation group (68 persons), and all other patients got different degrees of improvement. In 5 patients, urine ketosis was positive and blood ketone body was negative. The average blood glucose was 8.6 mmol / L. Twelve were dead in the control group (62), 8 were positive for urinary ketosis, and were blood testosterone-negative with an average of 9.3 mmol / L of random blood glucose. Two groups of patients except for the death of patients with blood gas analysis have improved. CONCLUSION: Glucocorticoids are still the first choice in rescuing diabetes mellitus with chronic obstructive pulmonary disease (COPD), pulmonary heart disease complicated with type II respiratory failure and pulmonary encephalopathy, and no hyperglycemia appears. Compared with the combination of insulin and noradren 30R ) Hypoglycemic, a small number of patients with weak occult blood stool positive, and severe stress related. Urine ketone positive and poor patient eating related. The sooner the better glucocorticoid application. Due to the small number of patients observed, the safety needs to be confirmed by further observation.