普米克令舒联合可必特雾化吸入改善肺癌合并重度COPD患者术前肺功能及扩大手术适应症研究

Effect of nebulized pulmicort combined with combivent on patients with lung cancer complicated with severe chronic obstructive pulmonary disease and its expand surgical indications

目的观察普米克令舒联合可必特雾化吸入对肺癌合并重度COPD患者术前肺功能影响,探讨该疗法能否扩大肺癌手术的适应症。方法收集我院肺癌合并COPD,拟行肺叶切除术的患者,给予普米克令舒联合可必特雾化吸入两周后比较患者FEV1、MVV%、PaO2、PaCO2的改善情况及手术耐受情况。结果研究期间入组27例重度COPD合并肺癌Ⅰ-Ⅲa期患者,经治疗2周后FEV1、MVV%、PaO2、PaCO2均较治疗前显著改善(P<0.05)。其中有21例患者肺功能提高至手术指标,进行单侧肺叶切除并淋巴结清扫术,但与同期轻中度COPD合并肺癌患者比较,前者并发症发生率较后者增加(P<0.01)。结论雾化吸入普米克联合可必特可在短时间内明显提高肺癌合并重度COPD患者肺功能水平,可使其中部分患者较安全的耐受肺叶切除术。

Objective To investigate the effect of nebulized pulmicort combined with combivent on the lung function of patients with lung cancer complicated with severe chronic obstructive pulmonary disease（COPD）,and to determine whether the indications of lobectomy for lung cancer could be expanded through this treatment.Methods 27 severe COPD patients complicated with Ⅰ to Ⅲa stage lung cancer complicated with severe COPD were enrolled,and they were given nebulized pulmicort combined with combivent for two weeks.Their lung function and surgery tolerance were measured and compared.Results The improvement of MVV%,FEV1,PO2,and PCO2 was more pronounced two weeks after the inhalation treatment with significant difference（P0.05）.The lung function of 21 patients was improved to surgery indexes,and they were given pulmonary lobectomy to clean lymph nodes.Compared with those who underwent lobectomy during the same period but with only mild to moderate COPD,patients with severe COPD had a higher incidence of postoperative complications（P0.01）.Conclusion Nebulized pulmicort combined with combivent can improve the lung function of patients with lung cancer complicated with severe COPD at short term in order to keep some of them undertake lobectomy successfully.