慢性阻塞性肺疾病稳定期门诊治疗的临床研究

Clinical research of outpatient treatment for patients with stable chronic obstructive pulmonary disease

目的研究COPD稳定期的不同治疗方案。方法将90例COPD患者随机分为3组：舒利迭组（吸入沙美特罗氟替卡松50／250μg每天2次）、联合用药组（口服茶碱缓释片0．1g每天2次＋吸入丙酸氟替昔松125μg每天2次）及对照组（按需使用硫酸沙丁胺醇气雾剂），随访1年，观察1年后的肺功能（FEV1、FVC、FEV1％pred、FEV1/FVC和FEF25—75％），6分钟步行距离（6 minuteswalkingdistance，6MWD）和1年中急性加重的次数。结果治疗后舒利迭组和联合用药组的FEV1、FVC、FEV1％pred、FEV1／FVC、FEF25—75％和6MWD分别与对照组及治疗前比较均有改善（P值均〈0．05）；治疗后舒利迭组比联合用药组FVC和FEF2575％改善更明显（分别为2．41±0．61和2．11±0．47，44．9±10．1和35．4±8．8。P值均〈0．05）。结论舒利迭（50／250μg）、联合用药（口服茶碱缓释片＋丙酸氟替卡松气雾剂）对稳定期COPD患者疗效肯定，前者对FVC和FEF25—75％的改善较后者强。

Objective To research different treatment for patients with stable chronic obstructive pulmonary disease （COPD）. Methods The 90 patients were divided into three groups： shulidie group （inhaled salmeterol （50 μg） fluticasone （250μg） twice daily,drug combination group [raked theophylline retard tablets （0.1 g） by mouth and inhaled fluticasone （125 μg） twice daily] and control group（inhaled salbutamol in need）. Pulmonary function （ FEV1 , FVC, FEV1 % predicted, FEV1/FVC and FEF25 75 % ）, 6 minute walking distance and the exacerbations were observed during the 1 year treatment period. Results Both shulidie and drug combination groups resulted in improvements in pulmonary function （FEV1, FVC,FEV1 predicted,FEV1/FVC and FEF25-75%） and 6 minute walking distance at the end of the 1 year treatment period when compared with control group or baseline（all P 〈0.05）. Shulidie group improved the FEF25 75% and FVC value to a greater extent than control group （2.41±0.61 and 2.11 ±0.47,44.9±10.1 and 35. 4 ±8. 8, respectively, both P 〈0.05）.Conclusions The shulidie （50/250 μg） and combination drug （theophylline retard tablet and fluticasone aerosol） have effect for patients with stable COPD. The former has stronger effect to improve FVC and FEF25-75% than latter.