噻托溴铵联合沙美特罗替卡松对重度极重度慢性阻塞性肺疾病稳定期患者疗效分析

Effect of tiotropium combined with salmeterol/fluticasone propionate in patients with severe-to-very severe stable chronic obstructive pulmonary disease

目的探讨联合吸人沙美特罗替卡松及噻托溴铵对重度极重度稳定期COPD患者肺通气功能指标、活动耐力及生活质量的疗效观察。方法选取2008年1月至2010年2月河间市人民医院门诊收治的102例稳定期重度极重度COPD患者，采用完全随机法分成A、B、C3组，A组给予噻托溴铵干粉剂，B组给予沙美特罗替卡松50／500μg，C组给予噻托溴铵干粉剂与沙美特罗替卡松联合吸人，共治疗6个月，在治疗3个月和6个月时分别进行肺通气功能评定、运动耐力评定、健康相关生活质量评价。结果3组患者治疗后肺通气功能评定、运动耐力评定、健康相关生活质量评价较治疗前均有改善，C组比A、B2组各指标改善明显，差异有统计学意义（P值均〈0．05）。结论联合使用噻托溴铵和沙美特罗替卡松可以更好地改善重度极重度稳定期COPD患者肺通气功能、提高运动耐力及生活质量，且不良反应发生率低，值得临床推广。

Objective The purpose of the study was to investigate the effect of tiotropium combined with salmeterol/fluticasone propionate in patients with severe-to-very severe stable chronic obstructive pulmonary disease （COPD）. Methods One hundred and two patients admitted for severe-to- very severe stable COPD from January 2008 to February 2010 were randomly assigned to receive tiotropium alone （group A）, salmeterol/fluticasone propionate （50/500 μg） alone （group B）, and combination of tiotropium and salmeterol/fluticasone propionate （group C）, respectively, for 6 months. All patients were assessed at months 3 and 6 for pulmonary with ventilation function, exercise tolerance and health-related quality of life. Results At both months 3 and 6, pulmonary ventilation function, exercise tolerance,and health-related quality of life were improved in all groups compared with pretreatment values. Moreover, significantly greater improvement of the three indicators was observed in group C than in groups A and B （all P 〈0.05）. Conclusions The combination of tiotropium and salmeterol/fluticasone propionate was superior to any single-agent treatment in improving pulmonary ventilation function, exercise tolerance, and quality of life in patients with severe-to-very severe stable COPD, without additional adverse effects. Therefore, it should be encouraged in clinical practice.