噻托溴铵联合夜间氧疗对COPD夜间睡眠低氧的疗效研究

Therapeutic effect of tiotropium bromide in combination with nocturnal oxygen therapy on nocturnal hypoxemia in patients with chronic obstructive pulmonary disease

目的:探讨噻托溴铵联合夜间氧疗对慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)夜间睡眠低氧的治疗作用,并间接评价噻托溴铵对夜间睡眠低氧的疗效。方法:选择存在夜间睡眠低氧的稳定期中重度COPD患者40例,随机分为2组,观察组(20例)给予吸入噻托溴铵(18μg,每日午后1次)联合夜间氧疗(2 L/min),对照组(20例)给予单纯夜间氧疗(2 L/min),分别在治疗前和治疗4周后检测夜间睡眠血氧饱和度、血气分析、肺功能。结果:2组治疗后与治疗前比较:观察组夜间平均血氧饱和度(Nocturnal mean SaO2,MSaO2)、夜间最低血氧饱和度(Nocturnal minimum SaO2,MmSaO2)、动脉血氧分压(Arterial partial pressure of oxygen,PaO2)、动脉血氧饱和度(Arterial oxygen saturation,SaO2)、第1秒用力呼气容积(Forced expiratory volume in one second,FEV1)、FEV1占预计值百分比(Percentage of FEV1 in the predicted value,FEV1%Pred)、用力肺活量(Forced vital capacity,FVC)、深吸气量(Inspiratory capacity,IC)、呼气峰值流速占预计值百分比(Percentage of peak expiratoryflow rate in the predicted value,PEF%Pred)显著提高;对照组MSaO2、MmSaO2、PaO2、SaO2明显升高,而FEV1、FEV1%Pred、FVC、IC、PEF%Pred则无明显改变;2组夜间血氧饱和度小于90%的时间占总睡眠时间的百分比(T90)显著降低;观察组动脉血二氧化碳分压(Arterial partial pressure of carbon dioxide,PaCO2)明显降低,而对照组PaCO2则明显升高。2组治疗后比较:观察组MSaO2、MmSaO2、PaO2、SaO2明显提高,T90、PaCO2显著降低,FEV1、FEV1%Pred、FVC、IC、PEF%Pred显著提高。结论:噻托溴铵联合夜间氧疗能显著改善COPD夜间睡眠低氧,并优于单纯夜间氧疗;噻托溴铵也能改善COPD夜间睡眠低氧。

Objective：To investigate the therapeutic effect of tiotropium bromide in combination with nocturnal oxygen therapy on nocturnal hypoxemia in patients with chronic obstructive pulmonary disease（COPD） and to evaluate indirectly the efficacy of tiotropium bromide for nocturnal hypoxemia.Methods：Totally 40 patients with stable moderate to severe COPD and nocturnal hypoxemia were recruited and randomly divided into the observation group（n=20） and the control group（n=20）.The patients in the observation group were given inhalative tiotropium bromide（18 μg,once every afternoon） in combination with nocturnal oxygen therapy（2 L/min） while those in the control group were treated with nocturnal oxygen therapy（2 L/min） only.Nocturnal oxygen saturation（SaO2）,arterial blood gases and pulmonary function were examined before and four weeks after the treatment.Results：After the treatment,nocturnal mean SaO2（MSaO2）,nocturnal minimum SaO2（MmSaO2）,arterial partial pressure of oxygen（PaO2）,arterial SaO2,first second forced expiratory volume（FEV1）,percentage of FEV1 in the predicted value（FEV1%Pred）,forced vital capacity（FVC）,forced inspiratory capacity（IC） and percentage of peak expiratory flow rate in the predicted value（PEF%Pred） were significantly increased in the observation group.In the control group,MSaO2,MmSaO2,PaO2 and SaO2 were significantly increased,but no change in FEV1,FEV1%Pred,FVC,IC and PEF%Pred was observed.Both groups showed significant decreases in the percentage of the time with nocturnal SaO290% in the total sleep time（T90）.Arterial partial pressure of carbon dioxide（PaCO2） was significantly decreased in the observation group;however it was remarkably increased in the control group.After the treatment in the observation group,MSaO2,MmSaO2,PaO2 and SaO2 were significantly increased;T90 and PaCO2 were significantly decreased;FEV1,FEV1%Pred,FVC,IC and PEF%Pred were notably increased compared with those in the control group.Conclusion：Tiotropium bromide in combination with nocturnal oxygen therapy could significantly improve the symptoms of nocturnal hypoxemia in patients with stable COPD,which is superior to nocturnal oxygen therapy alone.Meanwhile,tiotropium bromide could also improve the symptoms of nocturnal hypoxemia in patients with stable COPD.