运动锻炼配合噻托溴铵、沙美特罗／替卡松联合吸人治疗慢性阻塞性肺疾病稳定期疗效分析

Therapeutic effects of exercise combined with tiotropium bromide and inhaling on stable chronic obstructive pulmonary disease

目的观察运动锻炼配合噻托溴铵、沙美特罗／替卡松吸入对慢性阻塞性肺疾病（COPD）稳定期的疗效。方法将COPD稳定期Ⅲ～Ⅳ级患者60例依据随机数字表法分为对照组（药物）和试验组（药物＋锻炼），对照组联合吸入噻托溴铵粉雾剂及沙美特罗，替卡松干粉剂，试验组在药物治疗同时配合运动锻炼（缩唇呼吸和踏阶梯运动），疗程均为8周；治疗前后以第1秒用力呼气容积（FEV，）、FEV．占预计值百分比（FEV，％）、FEV．／用力肺活量（FVC）、MRC评分、日常生活活动能力（ADL）评分、6rain步行距离（6MwD）等指标评价疗效。结果试验组、对照组治疗前后组内各指标比较差异均有统计学意义（P〈0．01）；治疗后试验组、对照组FEV1[（1．41±0．25）L比（1．28±0．23）L]、FEV，％i（53．76±11．17）％比（46．27±8．85）％]、FEV1／FVc【（62．12±10．78）％比（55．76±8．57）％]、MRC评分[（1．56±1．16）分比（2．29±1．13）分]、ADL评分[（5．51±0．18）分比（4．47±O．13）分]、6MWD[（342．7±19．7）m^（280．6±17．8）m]比较差异有统计学意义（P〈0．05）。结论配合运动锻炼能显著改进噻托溴铵、沙美特罗，替卡松联合吸入对COPD稳定期患者的疗效。

Objective To observe the therapeutic effects of exercise combined with tiotropium bromide and salmeterol/fluticasone inhaling on stable chronic obstructive pulmonary diseases （COPD）. Methods Sixty COPD patients with pulmonary function Ⅲ- Ⅳ grade were randomly allocated into experiment group and control group （30 cases in each group）. The patients in experiment group were treated with inhaled tiotropium bromide and salmeterol/fluticasone combined With excise, while the patients in control group were treated only with inhaled tiotropium bromide and salmeterol/fluticasone. Respiratory training with shrinkage lip respiration and steps training was given to the patients in experiment group for 8 weeks. Main outcome measures included forced expiratory volume in one second （FEV1）, FEV1 in the anticipation value （FEVI%）,FEVi/forced vital capacity （FVC）,Medical Research Council （MRC） score,activities of daily living （ADL） score and 6-minute walking distance （6MWD）. Results MRC score in control group and experiment group was both lower than that of pre-treatment （P 〈 0.01 ）. ADL score,6MWD and pulmonary functional parameters in both groups were improved than those of pre-treatment （P 〈 O.01 ）. FEV1, FEV%, FEVJFVC,MRC score,ADL score and 6MWD were （1.41 ±0.25） L, （53.76 ± 11.17）% , （62.12 ± 10.78）%, （1.56 ± 1.16） scores, （5.51 ± 0.18） scores and （342.7 ± 19.7） m after treatment in experiment group,and （ 1.28 ± 0.23 ） L, （46.27 ± 8.85 ）%, （55.76 ± 8.57 ）%, （2.29 ±1.13 ）scores, （4.47 ± 0.13 ）scores and （280.6 ±17.8）m after treatment in control group. There were significant differences between two groups （P 〈 0.05 ）. Conclusion Tiotropium bromide, salmeterol/fluticasone inhaling can improve life quality and pulmonary functional parameters in patients with stable COPD,while exercise combined with that can significantly enhance the therapeutic effects.