沙丁胺醇、丙酸倍氯米松和溴化异丙托品联合雾化吸入治疗慢性阻塞性肺疾病急性加重

Combined aerosol inhalation of salbutamol, beclometasone dipropionate and ipratropium bromide in acute exacerbation of chronic obstructive pulmonary disease

目的 探讨沙丁胺醇、丙酸倍氯米松和溴化异丙托品三者联合雾化吸入对慢性阻塞性肺疾病急性加重（AECOPD）患者肺功能及动脉血气的影响.方法 以本院2011年1月至2014年1月收治的AECOPD患者108例为研究对象,随机数字表分为对照组（n=54）和联合治疗组（n=54）.对照组采用常规治疗,联合治疗组加用沙丁胺醇、丙酸倍氯米松和溴化异丙托品雾化吸入治疗.治疗前及治疗后第7天进行两组患者动脉血气分析,记录动脉血pH值、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）;并测定肺功能,记录第1秒用力呼气容积（FEV1）、FEV1占预计值％（FEV1％pred）和用力肺活量（FVC）.结果 血气分析显示,治疗前两组患者动脉血pH值、PaO2和PaCO2差异均无统计学意义（均P＞0.05）.治疗后两组患者动脉血pH值、PaO2和PaCO2均较治疗前显著改善（均P＜0.05）.与对照组比较,治疗后联合治疗组患者PaO2明显增加[（79.5±9.4） mmHg比（64.0±7.7） mmHg,P＜0.05;1mmHg=0.133 kPa],PaCO2明显降低[（49.3±11.5）mmHg比（61.0±12.2）mmHg,P＜0.05].治疗后两组患者动脉血pH值差异无统计学意义（P＞0.05）.治疗前两组患者FEV1、FEV1 ％pred、FVC差异均无统计学意义（均P＞0.05）.治疗后两组患者FEV1、FEV1％pred、FVC均较治疗前有显著改善（均P＜0.05）.与对照组比较,治疗后联合治疗组患者FEV1、FEV1％ pred、FVC均显著升高[（1.35±0.14）L比（1.18±0.11）L,（61.15±9.51）％比（54.55±8.71）％,（2.49±0.16）L比（2.19±0.17）L,均P＜0.05].结论 沙丁胺醇、丙酸倍氯米松和溴化异丙托品三者联合雾化吸入治疗AECOPD疗效较好.

Objective To investigate the effect of the combined aerosol inhalation of salbutamol,beclometasone dipropionate and ipratropium bromide on the pulmonary function and arterial blood gases in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.Methods One hundred and eight patients with AECOPD admitted to our hospital between January 2011 and January 2014 were included in this study,and were divided into the control group （n=54） and the combined treatment group （n=54） by random number table.The control group received conventional therapy,while the combined treatment group received combined aerosol inhalation of salbutamol,beclometasone dipropionate and ipratropium bromide based on the conventional therapy.Arterial blood gas analysis and pulmonary function test were performed on both groups before and 7 days after treatment.The pH value of arterial blood,arterial partial pressure of oxygen （PaO2） and arterial partial pressure of carbon dioxide （PaCO2）,as well as the forced expiratory volume in first second （FEV1）,percentage of FEV1 over the predicted value （FEV1%pred） and forced vital capacity （FVC） were recorded.Results The arterial blood gas analysis showed that there was no statistical difference in pH value of arterial blood,PaO2 and PaCO2 among patients in two groups before treatment （all P〉0.05）.As compared with pretreatment,the pH value of arterial blood,PaO2 and PaCO2 in both groups were significantly improved after treatment （all P〈0.05）.Compared with the control group,the combined treatment group showed a greater increase in PaO2 [（79.5±9.4） mmHg vs （64.0±7.7）mmHg,P〈0.05; 1 mmHg=0.133 kPa],and a greater reduction in PaCO2 [（49.3±11.5） mmHg vs （61.0± 12.2） mmHg,P〈0.05] after treatment.However,there was no statistical difference in arterial blood pH value between two groups after treatment （P〉0.05）.At baseline,there was no statistical significance on the FEV1,FEV1% pred or FVC between two groups （all P〉0.05）.As compared with pretreatment,the FEV1,FEV1% pred and FVC were significantly improved in both groups after treatment （all P〈0.05）.Compared with the control group,the FEV1,FEV1% pred and FVC showed greater increases in combined treatmem group after treatment [（1.35±0.14） L vs （1.18±0.11） L,（61.15±9.51）% vs （54.55±8.71）%,（2.49±0.16）L vs （2.19±0.17） L,all P〈0.05].Conclusion Combined aerosol inhalation of salbutamol,beclometasone dipropionate and ipratropium bromide has better efficacy in the treatment of AECOPD.