慢性阻塞性肺疾病患者对短效支气管扩张剂的急性舒张反应

Acute bronchodilation response in patients with chronic obstructive pulmonary disease after short-term bronchodilator inhalation

目的探讨中度至极重度慢性阻塞性肺疾病（COPD）患者对短效支气管扩张剂沙丁胺醇的急性舒张反应。方法收集2009年1月至2011年12月安徽医科大学第一附属医院呼吸内科中、重度COPD稳定期患者156例，其中男性123例，女性33例，年龄50～76岁，平均年龄（58±6）岁。停用支气管扩张剂48h后，先测定基线肺通气功能，吸入沙丁胺醇400μg30min后再测定肺通气功能，比较吸入沙丁胺醇前及吸入30min后1S用力呼气容积（FEV3）的改善情况。结果与基线肺通气功能比较，全部156例中重度COPD患者FEV．平均增加150ml。FEV。％pred平均增加9．1％，其中36例（23．1％）吸入支气管舒张剂后FEV，较吸入前改善≥12％，同时增加200ml。支气管舒张试验阳性组吸入前FEV。％pred为36．3±7．9，阴性组吸入前FEV1％pred为42．6±10．2。支气管舒张试验阳性组FEV，改善程度明显好于阴性组，阳性组舒张前、后FEV．％pred之间差异有显著性（P〈0．05）。阴性组吸入支气管舒张剂前的平均基线FEV，％pred高于阳性组，两者差异有显著性（P〈0．05）。结论部分COPD患者对短效支气管扩张剂显示较好的舒张反应，支气管舒张试验可呈阳性。

Objective To investigate the degree of acute improvement in spirometric indices after short-term bronchodilator inhalation among chronic obstructive pulmonary disease （COPD） patients. Methods 156 stable patients with moderate-to-very-severe COPD were enrolled between January 2009 to December 2011 （123 males and 33 females）, with the age ranged from 50 to 76 （58 ± 6） years. After wash-out of bronchodilator, spirometry was performed before and 30 min following 400 μg salbutamol inhalation. Forced expiratory volume in one second （ FEVI ） were compared between before and 30min following 400μg salbutamol inhalation. Results Compared with baseline, mean improvements were 150 ml in FEVI and absolute increase was 9.1% in FEVI% pred. In these patients, 36 cases（23.1% ） had /〉12% and I〉200 ml improvements in FEVl. Mean pre- bronchodilator FEV % pred were 36.3 ± 7.9 in positive bronchodilator response patients and 42.6 ±10.2 in negative bronchodilator response patients. The data showed the improvement of positive patients was better than negative patients. FEV % of positive patients had significant difference in before and after （P 〈 0. 05 ）. The mean baseline of negative patients was higher than positive patients before inhaled. （P 〈 0. 05 ） Conclusion Partial patients with moderate-to-very-severe COPD demonstrate meaningful increase in lung, function followin administration of inhaled short-term bronchodilators.