溴化异丙托品对稳定期COPD患者肺功能及运动耐受性的影响

The impact of ipratropium bromide on lung function and exercise tolerance in patients with stable chronic obstructive pulmonary disease

目的 观察不同剂量的溴化异丙托品 (IPB)短时及长期应用 ,对稳定期慢性阻塞性肺疾病 (COPD)患者的肺功能及运动耐受性的影响。方法 37例稳定期COPD患者 ,随机分 3组 ,分别吸入IPB1 6 0 μg/次、80μg/次、40 μg/次。用药前后行肺功能及自行车功量仪极量运动负荷法运动试验测验。 结果 吸入IPB1 6 0 μg/次、80 μg/次组与安慰剂对照组相比 ,通气及运动指标均明显改善 (P <0 .0 1、P <0 .0 5 )。 40 μg/次组与安慰剂对照组相比 ,仅 1s量 (FEV1 )、每分最大通气量 (VEmax)改善 ,最大作功率 (Wmax)、每分最大摄氧量 (VO2 max)无明显改善。用药前后心率血压无明显变化。结论 溴化异丙托品可以改善通气 ,对气道阻塞的改善有量效关系。

Objective To compare the effects of varying doses of inhaled ipratropium bromide (TPB) and the impact on lung function and exercise tolerance using progressive cycle ergometry in patients with stable COPD.Methods Thirty seven patients with stable COPD of mean age 57.4 years and forced expiratory volume in one second (FEV 1.0 ) of 1.66 (0.50) L, were studied by progressive exercise tests on a cycle ergometry in a randomized double blind manner, these and placebo were administered with metered dose inhalers. Each of the three different dosage groups received ipratropium bromide at 160 μg,80 μg and 40 μg. The effects on the maximal ventilation (VE max ), heart rate, SaO2, maximal work rate (W max ), oxygen uptake (VO 2max) were determined at rest and at maximal workloads among the three different dosages groups.Results Ipratropium bromide at the dosages of 160 μg, 80 μg produced a greater increase in FEV1 VO 2max , W max , VE max than 40 μg or placebo. ( P<0.01,P<0.05 ) 40 μg tid for two weeks didn't produce greater improvement except in FEV1 and VE max . No changes were found in heart rate, blood pressure and SaO 2. No side effects were noted.Conclusion Ipratropium bromide can improve the ventilation, dyspnoea and exercise tolerance in patients with stable COPD, but has no significant effects on the cardiovascular system. (Shanghai Med J, 2000,23∶606 609)