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目的:观察茶碱在老年慢性阻塞性肺病(COPD)急性加重期的临床疗效,了解有效治疗的茶碱血药浓度。方法:选择老年COPD急性加重期患者60例,随机分为治疗组和对照组各30例,治疗组给予多索茶碱0.3 g,ivd,qd+茶碱缓释片0.1g,po,bid+地塞米松5 mg,ivd,qd;对照组给予特布他林0.5 mg雾化吸入q8h+地塞米松5 mg,ivd,qd。治疗组于用药后2 d、5d、10 d清晨6时测定茶碱浓度。比较两组的患者住院时间、治疗费用、临床疗效、治疗前后肺功能、血气分析的变化及不良反应。结果:两组患者的肺功能和血气分析在治疗后均有明显改善(P<0.01),两组住院时间、治疗效果、实验室指标的改善无统计学差异(P>0.05),但治疗组的治疗费用低于对照组(P<0.05),不良反应的发生例数较对照组少,其中心血管系统不良反应的发生率有统计学意义。所有检测的茶碱血药浓度均小于20μg·ml~(-1),其中仅8份标本血药浓度在10～20μg·ml~(-1)的治疗窗内。结论:茶碱在老年COPD急性加重期治疗中具有较好的临床应用价值,安全性高,值得推广。
Objective: To observe the clinical efficacy of theophylline in the elderly with acute exacerbation of chronic obstructive pulmonary disease (COPD) and to understand the effective theophylline concentration. Methods: Sixty elderly patients with acute exacerbation of COPD were randomly divided into treatment group (30 cases) and control group (30 cases). The treatment group was given doxofylline 0.3 g, iv, qd + theophylline sustained release tablets 0.1 g, po, bid + 5 mg, ivd, qd for 5 mg, ivd, and qd for control group, and 0.5 mg for terbutaline for inhalation q8h + dexamethasone for iv control. In the treatment group, theophylline concentration was measured at 6:00 on the 2nd, 5th, 10th day after the treatment. The hospitalization time, treatment cost, clinical curative effect, changes of lung function before and after treatment, blood gas analysis and adverse reactions were compared between the two groups. Results: The lung function and blood gas analysis of both groups were significantly improved after treatment (P <0.01). There was no significant difference in hospitalization time, treatment effect and laboratory indexes between the two groups (P> 0.05) (P <0.05). The incidence of adverse reactions was less than that of the control group, and the incidence of adverse cardiovascular reactions was statistically significant. All tested theophylline plasma concentrations were less than 20μg · ml ~ (-1), of which only 8 samples blood concentration in the therapeutic window of 10 ~ 20μg · ml ~ (-1). Conclusion: Theophylline has good clinical value in the treatment of elderly exacerbation of COPD, which is safe and worthy of promotion.