噻托溴铵联合N-乙酰半胱氨酸治疗慢性阻塞性肺疾病稳定期的疗效观察

摘要

目的 观察噻托溴铵联合N-乙酰半胱氨酸(NAC)治疗慢性阻塞性肺疾病(COPD)的临床疗效.方法 采用简单随机数表法将2015年1月至2016年1月在成都医学院第一附属医院呼吸内科住院治疗后病情稳定的128例COPD患者分为观察组与对照组,每组64例,对照组在常规治疗基础上单用噻托溴铵粉雾剂吸入治疗(18 μg/次,1次/d),观察组在对照组治疗的基础上加用NAC泡腾片口服(600 mg/次,1次/d),疗程均为4个月.比较两组患者治疗前后的呼吸困难(mMRC)分级、动脉血气指标和肺功能指标.结果 与治疗前比较,治疗后观察组和对照组mMRC分级均降低,且观察组较对照组mMRC分级下降更显著,差异均有统计学意义(P<0.05);治疗后,观察组和对照组动脉血氧分压(PaO2)和血氧饱和度(SaO2)均高于本组治疗前[(85.64±7.90)mmHg vs(59.77±10.85)mmHg、(77.56± 6.52)mmHg vs(58.61±8.70)mmHg和(95.13±2.61)% vs(86.64±5.76)%、(93.92±2.41)% vs(85.44±4.84)%],且观察组PaO2和SaO2较对照组升高更明显,差异均有统计学意义(P<0.05);治疗后,观察组和对照组动脉血二氧化碳分压(PaCO2)均低于本组治疗前[(42.58±5.53)mmHg vs(61.13±10.62)mmHg和(46.84±6.06)mmHg vs(58.61±8.70)mmHg],且观察组PaCO2较对照组下降更明显,差异均有统计学意义(P<0.05);治疗后,观察组和对照组第1秒用力呼气容积(FEV1)均高于本组治疗前[(1.78±0.51)L vs(1.36±0.58)L和(1.60±0.52)L vs(1.40±0.51)L],且观察组较对照组升高更明显,差异均有统计学意义(P<0.05);治疗后,观察组和对照组用力肺活量(FVC)和FEV1占预计值百分比(FEV1%pred)均较本组治疗前升高[(2.81±0.71) L vs (2.42±0.73) L、(2.52±0.74) L vs (2.36±0.73) L和(61.14±17.51)% vs (46.05± 17.56)%、(51.70±18.60)% vs(45.48±17.78)%],且观察组较对照组升高更明显,差异均有统计学意义(P<0.05),但对照组治疗前后差异均无统计学意义(P>0.05).结论 与单用噻托溴铵相比,噻托溴铵联合NAC对COPD稳定期患者呼吸困难症状、动脉血气指标及肺功能指标改善更显著.%Objective To investigate the therapeutic effect of tiotropium bromide combined with N-acetylcyste-ine(NAC)therapy for patients with stable chronic obstructive pulmonary disease(COPD).Methods A total of 128 sta-ble COPD patients after hospitalization in the First Affiliated Hospital of Chengdu Medical College from January 2015 to January 2016 were selected and randomly divided into observation group and control group by simple random number table method,with 64 patients in each group.The control group was given conventional therapy and inhalation treatment of tiotropium bromide(18 μg/time,qd),while the observation group was given conventional therapy and inhalation treat-ment of tiotropium bromide (18 μ g/time, qd) combined with NAC effervescent tables orally (600 mg/time, qd). The course of treatment was 4 months.Modified British Medical Research Council(mMRC)grades,arterial blood gas index and pulmonary function index before and after treatment in both groups were compared.Results After treatment,the patients in both observation and control groups had significant lower mMRC grades than those before treatment (P<0.05),and the patients in observation group had significant lower mMRC grades than those in control group(P<0.05). The patients in both observation and control groups had significant higher arterial partial pressure of oxygen(PaO2)and arterial blood oxygen saturate (SaO2) after treatment compared with before treatment: (85.64±7.90) mmHg vs (59.77± 10.85)mmHg,(77.56±6.52)mmHg vs(58.61±8.70)mmHg and(95.13±2.61)% vs(86.64±5.76)%,(93.92±2.41)% vs (85.44±4.84)%,respectively,P<0.05,and the patients in observation group had significant higher PaO2and SaO2than those in control group(P<0.05).The patients in both observation and control groups had significant lower arterial partial pressure of carbon dioxide (PaCO2) after treatment compared with before treatment: (42.58 ± 5.53) mmHg vs (61.13 ±10.62)mmHg and(46.84±6.06)mmHg vs(58.61±8.70)mmHg,respectively,P<0.05,and patients of COPD in observa-tion group had significant lower PaCO2than those in the control group(P<0.05).Patients of COPD in both observation and control groups had significant higher forced expiratory volume in 1 second (FEV1) than those before treatment:(1.78±0.51)L vs(1.36±0.58)L and(1.60±0.52)L vs(1.40±0.51)L,respectively,P<0.05,and the patients in observation group had significant higher FEV1 than those in control group(P<0.05).Forced vital capacity(FVC)and percentage of FEV1 in predicted value(FEV1%Pred)in both groups increased after treatment than before treatment:(2.81±0.71)L vs (2.42±0.73)L,(2.52±0.74)L vs(2.36±0.73)L and(61.14±17.51)% vs(46.05±17.56)% and(51.70±18.60)% vs(45.48± 17.78)%,respectively,P<0.05.There were significant differences between the observation group and the control group after treatment and between before and after treatment in the observation group(P<0.05),but the difference was not sta-tistically significant in the control group(P>0.05).Conclusion Compared with using tiotropium bromide alone,tiotro-pium bromide combined with NAC has more significant clinical therapeutic effect for the treatment of COPD patients in aspects of improving dyspnea,arterial blood gas index and pulmonary function index.