沙美特罗替卡松粉吸入剂联合社区干预治疗慢性阻塞性肺疾病

Treatment of chronic obstructive pulmonary disease with salmeterol/fluticasone propionate and community intervention

目的探讨沙美特罗替卡松粉吸入剂（舒利迭）联合社区干预治疗对慢性阻塞性肺疾病（COPD）稳定期患者肺功能和生存质量的影响。方法收集2008年3月至2009年3月处于稳定期的COPD患者96例，采用简单随机化分组法分为A、B两组，各48例。A组单用舒利迭治疗6个月，B组在用舒利迭基础上全程接受社区干预，干预内容包括健康教育、心理干预、运动训练及营养指导。检测两组患者治疗前后肺功能的变化，并通过圣·乔治呼吸问卷（SGRQ）评估生存质量。结果除了A组疾病影响评分外，两组患者治疗后肺功能指标第1秒用力呼气容积（FEV1）、FEV1占预计值％A组分别为（1．78±0．16）L和（65±9）％，B组分别为（2．05±0．28）L和（73±9）％；生存质量评分中呼吸症状、活动受限及SGRQ在A组分别为40±18、36±16和125±40，B组分别为21±10、20±11和58±28。明显优于治疗前FEV1和FEV1占预计值％[A组分别为（1．59±0．15）L和（58±7）％，B组为（1．61±0．14）L和（58±8）％；呼吸症状、活动受限和SGRQ评分A组分别为63±22、50±24和167±68，B组为62±22、48±22和163±67]（P〈0．05）；治疗后B组的肺功能指标、生存质量评分等方面更明显优于A组（P〈0．05）。结论对COPD稳定期患者采用舒利迭联合社区干预治疗比单一舒利迭治疗改善肺功能和提高生存质量的作用更有效，具有临床推广价值。

Objective To investigate the effects of salmeterol/fluticasone （seretide） combined with community intervention on lung function and quality of life of chronic obstructive pulmonary disease （COPD） patients in the stable period. Methods 96 cases with COPD in the stable period were divided into two groups randomly：Group A was treated only by seretide for six mouths, group B was treated by seretide combined with community intervention （health education, psychological intervention, exercise training, and nutritional guidance）. 6 months later,the lung function was determined and the quality of life was assessed by SGRQ. Results The lung function and the score of the quality of life in two groups after treatment [Group A： （1.78 ±0. 16）L,（65 ±9）% and40 ±18,36 ±16,125 ±40;group B： （2.05 ±0.28）L,（73 ± 9）% and 21 ±10,20 ± 11,58 ± 28,respectively] were improved than those before treatment [ Group A： （1.59 ±0. 15） ,（58 ±-7） and 63 ±22,50 ±24,167 ±68;group B： （1.61 ±0. 14）L,（58 ±8）% and 62 ± 22,48 ± 22,163 ± 67, respectively] （P 〈 0.05 ） ;The lung function and the score of the quality of life in B group were improved than those in A group after treatment （ P 〈 0. 05 ）. Conclusions Using community intervention combined with seretide in treatment of COPD patients has better effect than the single use of seretide therapy,it improves lung function and quality of life. It is a safe treatment method and worthy to spread widely.