沙美特罗替卡松治疗中重度支气管哮喘的临床观察

摘要

目的：观察沙美特罗替卡松治疗中重度支气管哮喘的临床疗效及安全性。方法：选取我院中重度支气管哮喘患者98例，按照随机数字表法分为对照组（49例，3例病例脱落，共46例完成研究）和观察组（49例，2例病例脱落，共47例完成研究）。对照组患者给予布地奈德气雾剂1吸，bid；观察组患者给予沙美特罗替卡松气雾剂1吸，bid。两组疗程均为2个月。比较两组患者临床疗效、肺功能指标、临床症状基本消失时间、一秒用力呼气容积（FEV1）下降20％所需的最低累积剂量（PD20）、哮喘控制测试表（ACT）评分、半年内哮喘发作次数、血清和痰液中嗜酸性粒细胞百分比（EO％）和嗜酸性粒细胞阳离子蛋白（ECP）含量以及不良反应发生情况。结果：治疗后，观察组患者总有效率（95.73％）明显高于对照组（76.09％）；两组患者的用力肺活量（FVC）、FEV1和最大呼气峰流速（PEF）等指标值均明显升高，且观察组患者明显高于对照组；观察组患者肺部啰音、喘息、呼吸困难和咳嗽等临床症状消失时间均明显短于对照组；两组患者PD20和ACT评分均较治疗前明显升高，且观察组患者ACT评分明显高于对照组；观察组患者血清和痰液中EO％和ECP均明显低于对照组，上述差异均有统计学意义（P＜0.05）。观察组患者半年内哮喘发作次数低于对照组，但差异无统计学意义（P＞0.05）。出现不良反应的患者停药后症状均消失。结论：沙美特罗替卡松治疗中重度支气管哮喘的疗效优于布地奈德，可显著改善患者的肺功能，缩短相关临床症状消失时间，降低炎症因子水平，且安全性较好。%OBJECTIVE:To observe clinical efficacy and safety of salmeterol and fluticasone propionate in the treatment of mod-erate and severe bronchial asthma. METHODS:98 patients with moderate and severe bronchial asthma were selected from our hospi-tal were included in the study and were randomly divided into control group(49 cases,3 cases withdrew from the test and 46 cases completed the test)and observation group(49 cases,2 cases withdrew from the test and 47 cases completed the test). Control group was given Budesonide aerosol preparation,1 dose,bid;observation group was given Salmeterol and fluticasone propionate inhala-tion,1 dose,bid. The treatment course lasted for 2 months. Clinical efficacy,lung function indexes,the time of clinical symptom disappearance,FEV1,PD20,ACT score,asthma attack times within half an year,EO%and ECP in serum and sputum,and the oc-currence of ADR were compared between 2 groups. RESULTS:After treatment,total effective rate of observation group was signifi-cantly higher than that of control group(95.73% vs. 76.09%);FVC,FEV1 and PEF and other indexes of 2 groups were increased significantly,and the observation group was significantly higher than the control group;the disappearance time of pulmonary rales, wheezing,dyspnea and cough in observation group were significantly shorter than in control group;PD20 and ACT score of 2 groups were significantly increased,ACT score of observation group was significantly higher than that of control group;EO% and ECP in serum and sputum of observation group were significantly lower than those of control group,there was statistical significance (P<0.05). Asthma attack times within half an year in observation was less than control group,there was no statistical significance (P>0.05). All ADRs disappeared after drug withdrawal. CONCLUSIONS:Therapeutic efficacy of salmeterol and fluticasone propio-nate is better than budesonide in the treatment of moderate and severe bronchial asthma,and can effectively improve lung function, shorten the time of clinical symptoms disapperance and reduce the level of inflammatory factor with and good safety.