沙美特罗氟替卡松联合异丙托溴铵吸入治疗对慢性阻塞性肺疾病稳定期患者BODE指数的影响

Effect on the BODE index by salmeterol xinafoate and fluticasone propionate powder for inhalation combined ipratropium bromide aerosol in patients with stable chronic obstructive pulmonary disease

目的评估沙美特罗氟替卡松联合异丙托溴铵气雾剂对慢性阻塞性肺疾病（COPD）稳定期患者BODE指数的影响。方法将120例COPD稳定期患者按随机数字表法分为对照组与观察组，每组60例。对照组患者接受异丙托溴铵雾化吸入，观察组接受沙美特罗氟替卡松联合异丙托溴铵吸人，疗程6个月。比较两组治疗前后的BODE指数、SGRQ问卷分数及血浆皮质醇、骨密度的变化。结果两组治疗前BODE指数总分比较差异无统计学意义（P〉0．05）；观察组治疗后BODE指数中呼吸困难量表评级、第1秒用力呼气容积占预计值百分比、6min步行试验距离、BODE指数总分均显著优于对照组[（1．9±0．5）级比（2．3±0．5）级、（58．5±7．3）％比（50．4±6．2）％、（411．1±56．8）m比（347．5±60．4）m、（3．3±1．0）分比（3．8±1．3）分]，差异有统计学意义（P〈0．05）。两组治疗前SGRQ评分比较差异无统计学意义（P〉0．05），观察组治疗后SGRQ呼吸症状、活动受限及疾病影响各项及总分均显著优于对照组[（20．7±10．3）分比（37．9±14．4）分、（20．7±9．5）分比（34．8±13．0）分、（16．3±6．7）分比（27．2±11．8）分、（17．5±7．0）分比（34．6±12．3）分]，差异有统计学意义（P〈0．01）。两组治疗前后血浆皮质醇、骨密度比较差异无统计学意义（P〉0．05）。结论沙美特罗氟替卡松联合异丙托溴铵吸入治疗COPD稳定期患者可显著改善患者肺功能，提高生活质量，不良反应少。

Objective To evaluate the clinical effect of salmeterol xinafoate and fluticasone propionate powder for inhalation combined ipratropium bromide aerosol in patients with stable chronic obstructive pulmonary disease （COPD）. Methods One hundred and twenty patients with stable COPD was randomly divided into control group and observation group with 60 patients each. The control group was received ipratropium bromide aerosol inhalation, and the observation group was given salmeterol xinafoate and fluticasone propionate powder for inhalation and ipratropium bromide aerosol for 6 months. BODE index, SGRQ scores, plasma cortisol and bone mineral density were compared between two groups before and after treatment. Results BODE index scores had no significant difference between two groups before treatment （P 〉 0.05）. After treatment, BODE index scores, dyspnea scale, FEV1%, 6MWD and BODE index total scores in observation group were superior to those in control group [ （1.9 ± 0.5） grades vs. （2.3 ± 0.5） grades, （58.5 ± 7.3）% vs.（50.4 ±6.2）%, （411.1 ±56.8） m vs. （347.5 ± 60.4） m, （3.3 ±1.0） scores vs. （3.8 ±1.3 ） scores ] ,there were significant differences （P 〈 0.05 ）. SGRQ scores had no significant difference between two groups before treatment （P 〉 0.05 ）. After treatment and in SGRQ scores, respiration symptom, limitation of activity, disease influence scores in observation group were significantly lower than those in control group [ （ 20.7 ±10.3 ） scores vs. （ 37.9 ±14.4 ） scores, （20.7 ± 9.5 ） scores vs. （34.8 ± 13.0） scores, （ 16.3 ± 6.7） scores vs. （27.2 ±11.8） scores, （ 17.5 ± 7.0） scores vs. （34.6 ± 12.3） scores ],there were significant differences （P 〈 0.01 ）. There were no significant difference of plasma cortisol and bone mineral density between two groups （P 〉 0.05 ）. Conclusions Salmeterol xinafoate and fluticasone propionate powder for inhalation and ipratropium bromide aerosol in patients with stable COPD can greatly improve the lung function and life quality and with less adverse reaction.