支气管哮喘患者肺功能与β_2受体激动剂的干预效应

Pulmonary function and intervention effects of β_2 receptor agonist in patients with bronchial asthma

目的：观察吸入β_2受体激动剂沙丁胺醇对支气管哮喘患者肺功能的影响。 方法：①选择2003-01／2004-07四川大学华西医院呼吸内科门诊就诊和住院的急性发作期和缓解期哮喘患者200例。患者对治疗方案均知情同意。②重度急性发作期哮喘患者86例为急性期沙丁胺醇吸入组，男41例，女45例。将缓解期哮喘患者114例随机分为2组，缓解期沙丁胺醇吸入组34例，缓解期沙丁胺醇+糖皮质激素吸入组80例。③急性期沙丁胺醇吸入组：患者静息20min后测定最大呼气流量-容积曲线和气道阻力2次，取最佳值作为基础值，然后即刻吸入硫酸沙丁胺醇吸入雾化剂3喷(300μg)，休息15min后重复测定上述指标。缓解期沙丁胺醇吸入组：患者肺功能基础值测定方法同急性期沙丁胺醇吸入组，以后给予沙丁胺醇吸入，每次200μg，3次／d，连续用药(46．2±12．9)d，再重复测定上述肺功能指标。缓解期沙丁胺醇+糖皮质激素吸入组：患者肺功能基础值测定方法及沙丁胺醇应用方法同缓解期沙 丁胺醇吸入组，同时加吸入型糖皮质激素，连续用药(43．0±5．2)d，再重复测定上述肺功能指标。④采用6200型体积描记仪测定肺功能(包括用力肺活量、第1秒用力呼气量、最大呼气流量、最大呼气中段流量，气道阻力，比气道传导率)。肺能变化率即为用药后各项肺功能指标测定结果-用药前各项肺功能指标测定结果。观察临床症状及用药后副作用。⑤多样本均数比较采用方差分析，组内或组间计量资料差异比较采用t检验。 结果：哮喘患者200例均进入结果分析。①3组用药前基础肺功能测值比较：急性期沙丁胺醇吸入组最差，与其他两组比较，差异明显(P<0．01)。缓解期沙丁胺醇吸入组、缓解期沙丁胺醇+糖皮质激素吸入组间比较，第1秒用力呼气量、最大呼气流量、最大呼气中段流量、比气道传导率皆有显著差异(P<0．05～0．01)。②3组间用药后肺功能改变率：有显著差异(P<0．01)。急性期沙丁胺醇吸入组的用力肺活量、第1秒用力呼气量、气道阻力、比气道传导率改善率明显优于缓解期沙丁胺醇+糖皮质激素吸入组(P<0．01)，而最大呼气流量、最大呼气中段流量的改变率虽大于缓解期沙丁胺醇+糖皮质激素吸入组，但差异不明显(P>0．05)。但缓解期沙丁胺醇+糖皮质激素吸入组的第1秒用力呼气量、最大呼气流量、最大呼气中段流量、比气道传导率改善率则明显优于缓解期沙丁胺醇吸入组(P<0．01)。③不良反应比较：缓解期组患者经长期用药后发生不良事件的副反应患者比例较小，不足6％。 结论：β_2受体激动剂沙丁胺醇用于急性发作期哮喘患者效果最佳，药物副作用少；若要长期用于治疗中、重度哮喘患者，联合吸入型糖皮质激素更好。

AIM： To observe the effects of albuterol that β1 receptor agonist aspiration on pulmonary function in patients with bronchial asthma. METHODS： ① 200 patients with asthma during acute episode phase and remission phase, who were in hospital or hospitalized at the out-patient clinic of Department of Respiratory Medicine, West China Hospital, Sichuan University from January 2003 to July 2004. The patients were all agreed to take part in the experiment. ② Eighty-six severe asthma patients in the acute episode phase were considered as acute albuterol aspiration group, including 41 males and 45 females. 114 patients with asthma in remission phase were assigned randomly into 2 groups： albuterol aspiration group in remission phase with 34 cases and albuterol ＋ glucocorticoid aspiration group in remission phase with 80 cases. ③ Albuterol aspiration group in acute phase： The maximal expiratory flow （MEF）-volume curve and airway resistance for twice were detected after resting for 20 minutes. The best value was gained as basic value, and then sulfuric acid albuterol aspiration for three times （300 μg） was aspirated instantly, resting for 15 minutes the above-mentioned indexes were detected repetitively. Albuterol aspiration group in remission phase： The method to detect the basic value of pulmonary function was the same to that of the albuterol aspiration group in the acute phase. Then the albuterol aspiration was performed, 200 μg every time, three times a day, taking medicine continuously for （46.2 ±12.9） days, and the above-mentioned indexes of pulmonary function were detected repetitively. Albuterol ＋ glucocorticoid aspiration group in remission phase： The methods of detecting the basic value of pulmonary function and albuterol application were the same to those in the albuterol aspiration group in remission phase. Meanwhile, the aspiration glucocorticoid was added, giving medicine continuously for （43.0±5.2） days, and the detection of the above-mentioned indexes of pulmonary function was repeated. ④ The pulmonary function [including forced vital capacity （FVC）, forced expiratory volume in the first second （FEV1）, MEF, maximum mid-expiratory flow （MMEF）, airway resistance and specific airway conductance] was detected with 6 200 type plethysmography apparatus. Change rate of pulmonary function, i.e., determination results of indexes on pulmonary function after taking medicinethe resuits before taking medicine. The clinical symptom and ill effects after taking medicine were observed. ⑤ Multiple sample means were compared with analysis of variance. The measurement data within groups or among groups were compared with t-test. RESULTS： 200 patients with asthma were all involved in the result analysis. ① Comparison of measurement result of basic pulmonary function before taking medicine in the three groups： It was the worst in the albuterol aspiration group in the acute phase, as compared with the other groups, and the difference was significant （P 〈 0.01）. There were significant differences between albuterol aspiration group in remission phase and albuterol ＋ glucocorticoid aspiration group in remission phase on FEV1, MEF, MMEF specific airway conductance （P 〈 0.05-0.01）. ② Change rate of pulmonary function after taking medicine among the three groups： There were significant differences （P 〈 0.01 ）. The ameliorative rates of FVC, FEV1, airway resistance and specific airway conductance were significantly better than those in the albuterol ＋ glucocorticoid aspiration group in remission phase （P 〈 0.01）, while the change rates of MEF and MMEF were bigger than those in the albuterol ＋ glucocorticoid aspiration group in remission phase, but the difference was insignificant （P 〉 0.05）. However, the ameliorative rates of FEVI, MEF, MMEF and specific airway conductance in albuterol ＋ glucocorticoid aspiration group in remission phase were significantly better than those in the albuterol aspiration group in remission phase （P 〈 0.01）. ③ Comparison of ill reaction： There was small number of patients with ill reaction of ill events after taking medicine for a long time in patients during remission phase, less than 6%. CONCLUSION： The β2 receptor agonist, albuterol has the best effects for patients with asthma in acute episode phase with few ill effects; If it is for a sustained treatment in moderate and severe asthma patients, there will be better effects combining with aspiration glucocorticoid.