沙美特罗替卡松粉联合噻托溴铵治疗慢性阻塞性肺病稳定期C组患者的临床疗效观察

Clinical observation of salmeterol/fluticasone propionate combined with tiotropium bromide in treatment of stable COPD patients of group C

目的 观察吸入不同剂量沙美特罗替卡松粉（舒利迭）联合噻托溴铵治疗慢性阻塞性肺病（COPD）稳定期C组患者的疗效.方法 门诊选取72例COPD稳定期C组患者,随机分成3组,Ⅰ组单独吸入舒利迭（50μg沙美特罗/500 μg丙酸氟替卡松,2次/日）、Ⅱ组单独吸入噻托溴铵（18μg,1次/日）和Ⅲ组吸入舒利迭（50μg沙美特罗/250 μg丙酸氟替卡松,2次/日）＋噻托溴铵（18μg,1次/日）,共治疗12周.用药前后分别检测患者肺功能,应用改良的英国医学研究委员会呼吸困难量表（mMRC）进行评分、COPD评估测试（CAT）及6分钟步行试验（6MWT）.结果 Ⅰ、Ⅲ组患者肺功能指标、mMRC及CAT评分、6分钟步行距离均较治疗前明显改善（P＜0.05）;Ⅱ组患者肺功能指标改善不明显,6分钟步行距离、mMRC及CAT评分均较前改善（P＜0.05）.结论 沙美特罗替卡松粉（50 μg/250 μg,2次/日）联合噻托溴铵治疗COPD稳定期C组患者疗效确切,治疗风险未增加,值得临床推广.

Objective To observe the efficacy of different doses of salmeterol/fluticasone propio- nate combined with tiotropium bromide in treatment of stable COPD patients of group C. Methods Sev- enty-two patients with stable COPD of group C were recruited from outpatient and were randomly divided into three groups. Group I inhaled salmeterol/fluticasone propionate （50/500 I-~g twice daily） alone. Group II inhaled tiotropium bromide （ 18 Ixg once daily） alone. Group llI inhaled salmeterol/fluticasone propionate （50/250 tLg twice daily）and tiotropium bromide （ 18 tLg once daily）. All petients were detected pulmonary function,modified british medical research council（mMRC） ,COPD assessment test（CAT） and 6-minute walk test（6MWT）before and after 12 weeks of treatment. Results The patients of group I and llI had improvement at pulmonary function（ FEV1 ）, CAT, mMRC score and 6MWT, and had significantly statistically different（P 〈 0.05）. The patients of group ]I had no statistically different at FEV1. They had more improvement and significantly statistically different （P 〈 0.05）at CAT, mMRC score and 6MWT. Conclusion The efficacy of salmeterol/fluticasone propionatecombined （50/250 Ixg twice daily）with tiotropium bromide in treatment of stable COPD patients of group C were certain. The risk of treatment was not increased and worthy of wide application.