噻托溴铵联合沙美特罗/丙酸氟替卡松吸入治疗稳定期重度COPD患者的临床疗效

摘要

Objective:To explore the curative effect on treatment of severe COPD patients in stable phase by inhalation of Tiotropium Bromide combined with Salmeterol/Fluticasone Propionate.Method:Severe COPD patients in stable phase were selected, and were randomly divided into group A of 67 cases and group B of 71 cases.Based on health education,patients in group A were treated by Salmeterol/Fluticasone Propionate,and patients in group B were treated by Tiotropium Bromide combined with Salmeterol/Fluticasone Propionate.Two groups’ lung function,6MWT,SGRQ scores,blood gas and serum CRP levels were compared before and after treatment,curative effects of two groups were evaluated,COPD exacerbations and adverse reactions of two groups were recorded.Result:after 12 weeks treatment,two groups’ FEV1,FVC,FEV1%,6MWT,PaO2 levels were all increased,while SGRQ scores,PaCO2 and serum CRP levels were all decreased, combined with before treatment,the differences were statistically significant(t=3.76~7.09,P<0.05 orP<0.01).The FEV1,FVC, FEV1%,6MWT and PaO2 levels of group B were all higher than that in group A,SGRQ scores,PaCO2 and serum CRP levels of group B were all lower than that in group A,the differences were statistically significant(t=3.67~5.00, P<0.05).Total effective rate in group A and B were respectively 77.61% and 92.96%,the difference was statistically significant( χ2=6.55,P<0.05).COPD exacerbation rates in group A and B were respectively 14.93%and 4.23%,the difference was statistically significant( χ2=4.63,P<0.05).Except for 1 case sinus tachycardia and 1 case thirst,there was no other significant adverse reactions.Conclusion:It has good intervention effect on treatment of severe COPD patients in stable phase by inhalation of Tiotropium Bromide combined with Salmeterol/Fluticasone Propionate,improves lung function,biochemical and inflammation and other indicators,also improves exercise tolerance and quality of life,reduces exacerbations frequency,and has high safety,it is better than single drug’s effect.So it has a certain guidance and reference on intervention of severe COPD patients in stable phase.%目的：探讨噻托溴铵联合沙美特罗/丙酸氟替卡松吸入治疗稳定期重度COPD患者的临床疗效。方法：选取稳定期重度COPD患者随机分为A组67例，B组71例。在健康教育的基础上，A组予以沙美特罗/丙酸氟替卡松吸入治疗，B组予以噻托溴铵联合沙美特罗/丙酸氟替卡松吸入治疗。比较两组治疗前、治疗12周后的肺功能、6 min步行距离（6MWT）、圣·乔治呼吸疾病问卷（SGRQ）评分、血气指标及血清C-反应蛋白（CRP）水平，评价临床疗效，记录COPD急性发作及药物不良反应。结果：治疗12周后，两组FEV1、FVC、FEV1%、6MWT评分、PaO2水平均升高，SGRQ评分、PaCO2、血清CRP水平均降低，治疗前后比较差异均有统计学意义（t=3.76~7.09，P<0.05或P<0.01）。B组FEV1、FVC、FEV1%、6MWT评分、PaO2水平均高于A组，SGRQ评分、PaCO2、血清CRP水平均低于A组，两组比较差异均有统计学意义（P<0.05）。A、B组总有效率分别为77.61%、92.96%，两组比较差异均有统计学意义（χ2=6.55，P<0.05）；COPD急性发作率分别为14.93%、4.23%，两组比较差异均有统计学意义（χ2=4.63， P<0.05）。除窦性心动过速、口干各1例外，未见其他明显的药物不良反应。结论：噻托溴铵联合沙美特罗/丙酸氟替卡松吸入治疗稳定期重度COPD具有较好的干预效果，改善了患者的肺功能、生化和炎症等指标，提高了运动耐量和生活质量，降低了急性发作的频次，且具有较高的安全性，优于单一用药的效果，对稳定期重度COPD的干预治疗具有一定的指导和借鉴意义。