异丙托溴铵和特布他林联合治疗慢性阻塞性肺疾病稳定期的疗效

Inhalation of ipratropium bromide combined with terbutaline in treatment of stable chronic obstructive pulmonary disease

目的探讨异丙托溴铵和特布他林联合吸入对慢性阻塞性肺疾病(COPD)稳定期的疗效。方法73例稳定期ⅡA级COPD患者随机分两组,联合组38例,吸入异丙托溴铵40μg/次,3次/d,特布他林100μg/次,3次/d;特布他林组35例,吸入特布他林100μg/次,3次/d。治疗12周,监测治疗前后临床症状、血气分析和肺功能。结果68例完成试验,联合组临床总有效率为81.6%,特布他林组总有效率65.6%,联合组疗效明显优于特布他林组(P<0.05);治疗后联合组动脉血氧分压(PaO2)为(82.9±11.7)mm Hg,动脉血二氧化碳分压(PaCO2)为(41.5±3.1)mm Hg,深吸气量(IC)为(2.15±0.47)L,残气容积(RV)为(2.13±0.34)L,气道阻力(Raw)为(3.17±0.67)cm H2O.L-1.s-1,特布他林组分别为(74.4±10.4)mm Hg,(42.0±2.7)mm Hg,(1.83±0.36)L,(2.45±0.45)L,(3.47±0.54)cm H2O.L-1.s-1,与组内用药前相比均有显著改善(P<0.05);治疗后联合组PaO2、IC明显高于特布他林组(P<0.05),RV、Raw明显低于特布他林组(P<0.05);两组治疗后1秒钟用力呼气容积(FEV1)与治疗前比较无明显增加(P>0.05)。结论联合吸入异丙托溴铵和特布他林治疗COPD稳定期患者,可以明显改善临床症状及部分肺功能,效果优于单用特布他林组。

Objective To determine the outcome of inhalation therapy for stable chronic obstructive pulmonary disease（COPD） with ipratropium bromide and terbutaline. Methods Seventy-three patients with stable COPD were randomly divided into two groups,38 cases in inhaled ipratropium bromide （40 μg once, three times a day） combined with terbutaline（100 μg once,three times a day）,other 35 cases in inhaled terbutaline alone： terbutaline inhaled 100 μg once,three times a day. Before and After 12 weeks of treatment, clinical symptoms were observed, pulmonary function and arterialized capillary blood gas was measured. Results Sixty-eight patients finished the study. The clinical effect of combination group was 81.6% ,which was significantly higher than that of terbutaline group,65.6% （ P 〈0.05）. After therapy,the partial pressure of oxygen in arterial blood（PaO2 ） of combination group was （82.9 ± 11.7） mm Hg, partial pressure of carbon dioxide in arterial blood（PaCO2 ） was （41.5 ± 3.1） mm Hg, inspiratory capacity （IC） was （2.15 ± 0, 47） L,residual volume （RV） was （2.13±0.34） L, airway resistance （Raw） was （3.17±0.67） cm H2O ·L^-1·S^-1 ,and in terbutaline group,they were （74.4±10.4） mm Hg,（42.0±2.7） mm Hg,（1.83±0.36） L,（2.45±0.45） L, （3.47 ± 0.54） cm H2O·L^-1·S^-1, respectively, two groups showed significant improvements to that before therapy comparing in the same group（ P d0.05） ; PaO2 and IC were higher in combination group than in terbutaline group after therapy（ P 〈0.05）, whereas RV and Raw were lower in combination group than in terbutaline group（ P 〈0.05）. The forced expiratory volume in one second （FEV1） of two groups had no significant increase to that before therapy. Conclusion Inhalation therapy for stable COPD with terbutaline alone or plus ipratropium bromide can get improvements in clinical symptoms and pulmonary function,and the combination may be more efficient.