噻托溴铵联合舒利迭治疗稳定期中重度慢性阻塞性肺疾病患者的效果观察

Clinical effect of tiotropium bromide combined with seretide on treating moderate and severe chronic obstructive pulmonary disease patients in stable phase

目的：探讨噻托溴铵与舒利迭联合用药对中重度慢性阻塞性肺疾病（COPD）患者的治疗效果。方法2012年1月至2013年10月我院门诊收治稳定期中重度 COPD 患者76例，应用随机数字表随机分组，对照组给予舒利迭吸入治疗，每日早晚各1次，每次应用剂量为50μg/500μg；研究组在对照组基础上加用噻托溴铵粉吸入剂治疗，于专用装置内刺破胶囊后吸入，每日1次。两组均根据病情变化实施抗感染、止咳平喘等常规治疗。比较两组患者治疗后肺功能、血气指标、呼吸症状改善和6 min 行走最远距离。结果研究组患者治疗后1秒用力呼气容积、用力肺活量、1秒用力呼气容积/用力肺活量分别为（2.22±0.48）L、（3.28±0.32）L、（66.23±9.22）％，明显高于对照组[（1.78±0.35）L、（2.85±0.47）L、（56.83±7.85）％]，差异均有统计学意义（t 值分别为5.39、4.66、4.78，P 均＜0.01）。研究组患者治疗后动脉血氧分压为（72.83±5.28）mmHg，明显高于对照组[（65.36±3.22）mmHg]，动脉血二氧化碳分压为（43.28±3.52）mmHg，明显低于对照组[（48.76±2.85）mmHg]，差异均有统计学意义（t 值分别为7.44、7.45，P 均＜0.01）。研究组患者治疗后呼吸困难程度评分为（1.38±0.32）分，明显低于对照组[（1.76±0.35）分]，6 min 内行走最远距离为（428.36±32.85）m，明显高于对照组[（398.65±28.38）m]，差异均有统计学意义（t 值分别为4.93、4.21，P 均＜0.01）。结论应用噻托溴铵联合舒利迭治疗稳定期中重度 COPD 患者具有较好的临床效果，可通过改善患者动脉血氧分压来促进肺功能损伤的修复，并促进患者生存质量的提升。

Objective To investigate the clinical effect of tiotropium bromide combined with Seretide in treatment of moderate to severe chronic obstructive pulmonary disease（ COPD） patients. Methods From Jan. 2012 to Oct. 2013,76 severe COPD were selected as our subjects and they were randomly divided into the control group（38 cases）and research group（38 cases）. Patients in control group were used Seretide（1 time both at morning and night,the does was 50 μg/ 500 μg）,and in research group were given tiotropium bromide with thiophene beside Seretide（1 time every day）. The two groups were received routine treatment,including anti infection,cough and asthma,according to the change of illness. The pulmonary function,blood gas index, respiratory symptoms and 6 minutes walking distance（6 MWD）were recorded. Results Forced expiratory volume in one second（ FEV1）,forced vital capacity（ FCV）,FEV1 / FCV of patients in research group after ftreatment were（2. 22 ± 0. 48）L,（3. 28 ± 0. 32）L,（66. 23 ± 9. 22）% respectively,higher than those in the control group,and the differences were significant（（1. 78 ± 0. 35）L,（2. 85 ± 0. 47）L,（56. 83 ± 7. 85）% ;t= 5. 39,4. 66,4. 78;P 〈 0. 01）. Partial pressure oxygen（PaO2 ）of patients in research group after treatment was （72. 83 ± 5. 28）mmHg,significantly higher than that of control group（（65. 36 ± 3. 22）mmHg）. However, partial pressure of carbon dioxide（ PaCO2 ）was（43. 28 ± 3. 52）mmHg,significantly lower than the control group（（48. 76 ± 2. 85）mmHg;t = 7. 44,7. 45,P 〈 0. 01）. Dyspnea（ MMRC）score in research group was （1. 38 ± 0. 32）,lower than the control group（1. 76 ± 0. 35）,and 6 MWD was（428. 36 ± 32. 85）m,higher than that of control group（（398. 65 ± 28. 38）m;t = 4. 93,4. 21,P 〈 0. 01）. Conclusion The treatment plan of tiotropium bromide combine with Seretide on moderate and severe COPD patients is proved with the better clinical effect and it can improve the partial pressure of oxygen and then promote repair mechanism of lung injury as well as promote the quality of life of patients with ascension.