噻托溴铵联合沙美特罗/丙酸氟替卡松治疗慢性阻塞性肺疾病稳定期患者的临床效果

摘要

目的 探讨噻托溴铵联合沙美特罗/丙酸氟替卡松治疗慢性阻塞性肺疾病(COPD)稳定期患者的临床效果.方法 选择2014年9月至2016年9月海南省人民医院收治的COPD稳定期住院患者126例,根据随机数字表法分为对照组和观察组,各63例.对照组患者在常规吸氧和预防感染基础上给予沙美特罗/丙酸氟替卡松治疗,观察组患者在对照组治疗基础上联合应用噻托溴铵粉雾剂治疗;比较2组患者治疗前后肺功能、圣乔治呼吸问卷评分、6 min步行距离、血清高敏C反应蛋白、动脉血气分析指标水平、不良反应发生率及COPD急性发作率.结果 治疗后,2组患者用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC、6 min步行距离、动脉血氧分压均高于治疗前,且观察组高于对照组[(2.88±0.23)L比(2.61±0.27)L,(2.26±0.86)L比(1.84±0.22)L,(66±10)％比(59±10)％,(392±25)m比(319±25)m,(76±8)mmHg(l mmHg=0.133 kPa)比(60±7)mmHg];圣乔治呼吸问卷评分、血清高敏C反应蛋白及动脉血二氧化碳分压水平均低于治疗前,且观察组低于对照组[(32±5)分比(46±4)分,(16±3)mg/L比(23±3)mg/L,(43±7) mmHg比(46±7)mmHg],差异均有统计学意义(均P＜0.05).对照组与观察组不良反应发生率[25.4％ (16/63)比39.7％ (25/63)]比较差异无统计学意义(P＞0.05).对照组治疗过程中COPD急性发作率高于观察组[22.2％ (14/63)比7.9％ (5/63)],差异有统计学意义(x2=5.02,P＜0.05).结论 噻托溴铵联合沙美特罗/丙酸氟替卡松治疗COPD稳定期患者,可显著改善患者肺功能、活动耐量及生活质量,降低炎症因子水平,有助于控制病情发展,且安全性较好.%Objective To explore the effect of tiotropium bromide combined with salmeterol/fluticasone propionate on stable chronic obstructive pulmonary disease(COPD).Methods A total of 126 patients with COPD at stable phase admitted to Hainan General Hospital were randomly divided into control group and observation group,with 63 cases in each group.The control group was given salmeterol/fluticasone propionate on the basis of routine oxygen inhalation and prevention of infection;the observation group was given tiotropium bromide powder inhalation on the basis of control group.Lung function indexes,score of St.George's Respiratory Questionnaire (SGRQ),6 min walking distance(6MWD),level of serum high-sensitivity C-reactive protein(hs-CRP),arterial blood gas indexes,adverse reactions and acute attack of COPD were analyzed.Results After treatment,forced vital capacity (FVC),the first second forced expiratory volume (FEV1),FEV1/FVC,6MWD and arterial partial pressure of oxygen significantly increased compared to those before treatment;the indexes in observation group were significantly higher than those in control group [(2.88 ± 0.23) L vs (2.61 ± 0.27) L,(2.26 ± 0.86) L vs (1.84±0.22)L,(66±10)％ vs (59±10)％,(392±25)m vs (319 ±25)m,(76±8)mmHg vs (60± 7)mmHg] (all P ＜ 0.05).SGRQ score,hs-CRP level and partial pressure of carbon dioxide significantly decreased after treatment;the indexes in observation group were significantly lower than those in control group [(32±5) vs (46 ±4),(16 ±3)mg/L vs (23 ±3)mg/L,(43 ±7)mmHg vs (46 ±7)mmHg] (all P＜0.05).There was no significant difference of adverse reactions between control group and observation group[25.4％ (16/63) vs 39.7％ (25/63)] (P ＞0.05).The acute attack rate of COPD in control group was significantly higher than that in observation group [22.2％ (14/63) vs 7.9％ (5/63)] (x2 =5.02,P ＜ 0.05).Conclusion Tiotropium bromide combined with salmeterol/fluticasone propionate treating stable COPD can significantly improve lung function,activity tolerance and quality of life,inhibit inflammatory response and control disease progression with good safety.