沙美特罗替卡松联合噻托溴铵吸入对支气管哮喘合并慢性阻塞性肺疾病患者肺功能的改善作用

Clinical research of Salmeterol fluticasone propionate and Tiotropium bromide for improvement of pulmona-ry function in patients with chronic obstructive pulmonary disease and bronchial asthma

目的：探讨沙美特罗替卡松联合噻托溴铵吸入对支气管哮喘合并慢性阻塞性肺疾病（COPD）患者肺功能的改善作用。方法将89例COPD患者使用随机数字表法随机分为对照组46例和观察组43例。除常规治疗外，对照组给予雾化吸入沙美特罗替卡松50μg／500μg，2次／d；观察组在对照组基础上吸入噻托溴铵18μg，2次／d，治疗14 d后统计疗效、SGRQ评分、肺功能和血气分析指标，记录不良反应情况。结果观察组治疗总有效率明显优于对照组（86．1％与69．6％），差异有统计学意义（Z＝2．68，P＜0．05）；经治疗后观察组患者肺功能指标FEV1（L）、FEV1（％）、FEV1／FVC（％）明显高于对照组[（2．27±0．45）与（1．92±0.36），（64．27±16．11）与（53．64±15．55），（54．85±14．81）与（45．33±13．23）]，差异有统计学意义（t＝4.20、3.16、3．19，均P＜0．05）；治疗后观察组PaO2上升，PaCO2下降，SGRQ评分明显降低[（47．61±3．64）与（49.34±4．23），（67．33±5．56）与（63．66±5．21），（45．34±3．72）与（50．65±4．16）]，差异有统计学意义（t＝2．13、3．32、6．54，均P＜0．05）。结论沙美特罗替卡松联合噻托溴铵治疗支气管哮喘合并COPD疗效显著，可明显改善患者肺功能和呼吸情况，降低SGRQ评分，值得临床推广应用。

Objective To observe the improvement of Salmeterol fluticasone propionate and Tiotropium bromide for inhalation in the treatment of chronic obstructive pulmonary disease （COPD）with bronchial asthma patients.Methods 89 patients were randomly divided into the observation group with 46 cases and control group with 43 cases,both groups were given conventional therapy.The control group was given Salmeterol fluticasone propionate 50μg/500μg,twice a day;the observation group was given Tiotropium bromide 18μg, twice a day, based on the therapy of control group.The two groups were treated for 14 days,and then curative effect,score of SGRQ,pulmonary function and blood gas analysis index were evaluated, and adverse reactions were recorded.Results The total effective rate of treatment group was 86.1%,higher than that of the control group（68.6%） （Z=2.68,P〈0.05）;Compared with the control group after treatment,functional parameters[ FEV1 （L） ,FEV1 （%） and FEV1/FVC（%） ] of the observation group increased significantly,and the observation group were all higher than that of the control group [（2.27 ±0.45） vs （1.92 ±0.36）,（64.27 ±16.11） vs （53.64 ±15.55）,（54.85 ±14.81） vs （45.33 ± 13.23）],the differences were all statistically significant（t=4.20,3.16,3.19,all P〈0.05）;PaO2 of the two groups patients were increased and PaCO2 were decreased,scores of SGRQ were decreased obviously,and the change of the observation group was obviously[（47.61 ±3.64） vs （49.34 ±4.23）,（67.33 ±5.56） vs （63.66 ±5.21）, （45.34 ±3.72） vs （50.65 ±4.16）],the difference was statistically significant（t =2.13,3.32,6.54,all P〈0.05） .Conclusion Salmeterol fluticasone propionate and Tiotropium bromide for inhalation can improve lung func-tional parameters and respiratory conditions of the parents with COPD and bronchial asthma obviously, reduce the score of SGRQ,curative effect is distinct,worthy of clinical popularization and application.