Meta-analysis yakabudiswa muInternal Medicine inoratidza kuti mishonga inorwisa mabhakitiriya uye systemic glucocorticoids inobatanidzwa nekukundikana kwekurapa kushoma muvanhu vakuru vaneCOPDexacerbations kana ichienzaniswa ne placebo kana pasina kupindira kwekurapa.

Kuti aite kuongorora kwakarongeka uye meta-analysis, Claudia C. Dobler, MD, Bond University, Australia, nevamwe vakaongorora 68 randomized controlled trials, kusanganisira 10,758 varwere vakuru vane acute exacerbations.COPDvairapwa muchipatara kana kunze.Chidzidzo chacho chakafananidza kupindira kwemishonga ne placebo, kutarisira nguva dzose kana mamwe maitiro emishonga.

Kubatsira kwemishonga inorwisa mabhakitiriya uye systemic glucocorticoids

Muchidzidzo chekuenzanisa kwemazuva 7-10 ehurongwa hwemishonga inorwisa mabhakitiriya uye placebo kana kuchengetwa kwakajairika kwevarwere vanorwara kana vari kunze, pakupera kwekurapa, mishonga inorwisa mabhakitiriya inoenderana nekuregererwa kwekuwedzera kwechirwere, asi haina chekuita nechirwere ichi. kuoma kwekuwedzera uye nzvimbo yekurapa (OR = 2.03; 95% CI, 1.47- -2.8; mwero wehutano hwehuchapupu).Mushure mekupera kwekupindira kwekurapa, mukudzidza kwevarwere vane hunyoro hwekuwedzera, systemic antibiotic therapy inogona kuderedza kukundikana kwehutano hwehutano (OR = 0.54; 95% CI, 0.34-0.86; simba reuchapupu hune mwero).Varwere nevarwere vekunze vane hunyoro kusvika pakati nepakati kana kuwedzeredza, mishonga inorwisa mabhakitiriya inogona zvakare kuderedza dambudziko rekufema, kukosora uye zvimwe zviratidzo.

Saizvozvo, kune vanorwara nevarwere vekunze, systemic glucocorticoids inofananidzwa ne placebo kana kuchengetwa kwakajairika.Mushure memazuva 9-56 ekurapwa, systemic glucocorticoids haigoni kukundikana (OR = 0.01; 95% CI, 0- 0.13; hutano hwehuchapupu huri pasi), pasinei nemamiriro ekurapa kana chiyero chekuwedzera kwakanyanya.Pakupera kwemazuva 7-9 ekurapwa, varwere vane hunyoro kusvika kune zvakanyanya kuwedzera mukiriniki yekunze uye vari muchipatara vakaita kuti dyspnea yavo isunungurwe.Nekudaro, systemic glucocorticoids inosanganiswa nekuwedzera kwenhamba yezvese uye endocrine-zvine chekuita nezviitiko zvakashata.

Vatsvaguri vanotenda kuti zvichibva pane zvavakawana, vanachiremba nevamwe vavanoshanda navo vanofanirwa kuvimbiswa kuti mishonga inorwisa mabhakitiriya uye systemic glucocorticoids inofanira kushandiswa mune chero acute exacerbation.COPD(kunyangwe zvinyoro).Mune ramangwana, vanogona kukwanisa kuona zviri nani kuti ndevapi varwere vanozobatsirwa zvakanyanya nemishonga iyi uye iyo varwere vangave vasingabatsirwi (zvichibva pane biomarkers, kusanganisira C-reactive protein kana procalcitonin, eosinophils yeropa).

Unoda humwe humbowo

Maererano nevatsvakurudzi, pane kushayikwa kwemashoko akasimba pamusoro pezvinodiwa nemishonga inorwisa mabhakitiriya kana glucocorticoid therapy, uye uchapupu hwekushandiswa kwemimwe mishonga, kusanganisira aminophylline, magnesium sulfate, anti-inflammatory drugs, inhaled corticosteroids, uye short-acting bronchodilators.

Mutsvakurudzi akati aizoodza mwoyo vanachiremba kushandisa marapiro asina kuvimbiswa, akadai seaminophylline uye magnesium sulfate.Vatsvakurudzi vanotenda kuti kunyange zvazvo kune zvidzidzo zvakawanda paCOPD, mishonga yakawanda yekurapa kuwedzera kweCOPD haina uchapupu hwakakwana.Semuenzaniso, mukudzidzira kwekiriniki, tinowanzo shandisa bronchodilators inobata-pfupi kuti ibvise dyspnea panguva yekuwedzera kweCOPD.Izvi zvinosanganisira short-acting muscarinic receptor antagonists (ipratropium bromide) uye short-acting beta receptor agonists (salbutamol).

Pamusoro pekutsvagisa kwemhando yepamusoro, tsvakiridzo yakavimbika yekurapa zvinodhaka, vaongorori vakaratidzawo kuti mamwe marudzi ekupindira angave akakodzera kudzidza.

"Humwe humbowo huri kukura hunoratidza kuti mamwe marapirwo asiri emishonga, kunyanya ayo anotanga kurovedza muviri kutanga kwechikamu chekuwedzera, anogona kuvandudza mwero kusvika kune zvakanyanya kuwedzera kwevarwere veCOPD muchipatara.IAmerican Thoracic Society/European Respiratory Conference muna 2017 Mirayiridzo yakapihwa inosanganisira kurudziro (yakanyanya kuderera yehumbowo) panguva yekuiswa muchipatara kweacute exacerbation yeCOPD, usatange kugadziridzwa kwepulmonary, asi humwe humbowo hutsva hwakabuda kubva ipapo kuti tinoda humbowo hwakawanda hwemhando yepamusoro hwekutanga maekisesaizi panguva yekuwedzeredza kweCOPD Kuona kushanda kwekutanga maekisesaizi ekuwedzera kweCOPD.