脉冲震荡肺功能检查在噻托溴铵联合沙美特罗替卡松治疗稳定期慢性阻塞性肺疾病中的价值

摘要

目的 探讨脉冲震荡肺功能检查在噻托溴铵和沙美特罗替卡松联合治疗稳定期COPD的临床价值.方法100例中重度稳定期慢性阻塞性肺疾病患者按随机数字表法分为对照组和观察组各50例;对照组予沙美特罗替卡松治疗,观察组予噻托溴铵联合沙美特罗替卡松治疗;比较治疗前及治疗3个月、6个月时,两组的常规肺功能指标,IOS参数、6MWT、mMRC和CAT评分.结果观察组治疗3个月及6个月时FEV1、FEV1/FVC和6MWT评分均高于治疗前,且高于同期对照组(P<0.05);Fres、X5绝对值、R5、R20、mMRC和CAT评分均低于治疗前,且低于同期对照组(P<0.05);Fres、X5绝对值、R5和R20与FEV1、FEV1/FVC和6MWT评分呈负相关,与mMRC和CAT评分呈正相关(P<0.05).结论噻托溴铵和沙美特罗替卡松联合治疗可有效改善患者的常规肺功能、6MWT、mMRC和CAT评分,IOS参数与上述指标均具有较好的相关性,可作为一种新的评估COPD的病情严重程度的检测手段,值得临床推广.%Objective To investigate the clinical value of impulse oscillometry pulmonary function test in the treatment of sta -ble chronic obstructive pulmonary disease ( COPD) with tiotropium bromide and salmeterol-fluticasone propionate .Methods One hun-dred patients with moderate to severe COPD were divided into control or observation group ,50 in each group according to the random data table.Based on routine treatment,patients in the control group were treated with salmeterol-fluticasone,and the patients in the ob-servation group were given tiotropium bromide combined with salmeterol -fluticasone.Before and after treatment of 3 and 6 months,rou-tine pulmonary function,IOS parameters,6MWT score,mMRC score and CAT score were compared between the two groups .Results After treatment for 3 and 6 months,FEV1,FEV1/FVC and 6MWT scores of the observation group were significantly higher than before treatment and the control group (P<0.05).Fres,X5 absolute value,R5,R20,mMRC and CAT scores of the observation group after treatment for 3 and 6 months were significantly decreased when compared to before treatment and significantly lower than those of the control group at the same time ( P<0.05 ) .The correlation analysis showed that Fres ,X5 absolute values ,R5 and R20 were negatively correlated with FEV1,FEV1/FVC and 6MWT score,and were positively correlated with mMRC and CAT score (P <0.05).Conclu-sion Tiotropium bromide combined with salmeterol-fluticasone in the treatment of patients with stable COPD can effectively improve the pulmonary function,6MWT,mMRC and CAT scores.IOS parameters and the above indexes are well correlated .They can be used as a new means of evaluating COPD severity .It is worthy of clinical promotion .