噻托溴铵联合N-乙酰半胱氨酸治疗慢性阻塞性肺疾病的临床观察

Clinical Observation of Tiotropium Bromide Combined with N-acetylcysteine in the Treatment of Chronic Obstructive Pulmonary Disease

目的:观察噻托溴铵联合N-乙酰半胱氨酸(NAC)治疗慢性阻塞性肺疾病(COPD)的临床疗效及安全性。方法:将90例COPD患者随机均分为对照组与观察组,对照组患者采用基础治疗并单用噻托溴铵粉雾剂吸入治疗(18μg/次,qd),观察组患者在对照组治疗的基础上加用NAC泡腾片口服(600 mg/次,qd),两组患者疗程均为4周。观察两组患者的临床疗效,治疗前后的血气指标、肺功能指标,以及不良反应和复发情况。结果:观察组患者临床总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组患者动脉血氧分压[p(O2)]、血氧饱和度(Sp O2)和对照组患者p(O2)均显著高于本组治疗前,两组患者动脉血二氧化碳分压[p(CO2)]均显著低于本组治疗前,且观察组患者p(O2)、Sp O2均显著高于对照组,p(CO2)显著低于对照组,差异均有统计学意义(P<0.05);观察组患者1 s用力呼气容积(FEV1)、用力肺活量(FVC)及1 s用力呼气容积/用力肺活量(FEV1/FVC)和对照组患者FEV1及FEV1/FVC均显著高于本组治疗前,且观察组患者FEV1、FVC及FEV1/FVC均显著高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05),而对照组患者复发率显著高于观察组,差异有统计学意义(P<0.05)。结论:相比单用噻托溴铵,噻托溴铵联合NAC治疗COPD临床疗效更显著,改善患者肺功能效果更显著,复发率更低,而安全性相当。

OBJECTIVE： To observe the clinical efficacy and security of tiotropium bromide combined with N-acetylcysteine （NAC） in the treatment of chronic obstructive pulmonary disease （COPD）. METHODS： 90 cases of COPD were randomly divid- ed into control group and observation group. Control group was given basic treatment and inhalation treatment of tiotropium bro- mide （18 μg/times, qd）, while observation group was accepted tiotropium bromide combined with NAC effervescent tablets orally （600 mg/times, qd）, the course lasted for 4 weeks. Clinical efficacy, indicators of blood gas and pulmonary function before and af- ter treatment, adverse reactions and recurrence were observed. RESULTS： Clinical efficacy in observation group was significantly hisher than control group, there was significant difference （P〈 0.05 ）. After treatment ,p （02） and SpO2 in observation group and p （02） in control group were significantly higher than before treatment, the p（CO2） in 2 groups were significantly lower than before treatment, and p （O2） and SpO2 in observation group were significantly higher than control group,p （CO2） was significantly lower than control group. There were significant differences （P〈0.05）. The FEV1, FVC, FEV1/FVC in observation group and FEV1, FEV1/FVC in control group were significantly higher than before, The FEV1, FVC and FEV1/FVC in observation group were sig- nificantly higher than control group. There were significant differences （P〈0.05）. There was no significant difference in the inci- dence of adverse reactions in 2 groups （P〉0.05） ; and recurrence in control group was significantly higher than observation group, there was significant difference （P〈0.05）. CONCLUSIONS： Compared with using tiotropium bromide alone, tiotropium bromide combined with NAC has significant clinical efficiency for the treatment of chronic obstructive pulmonary disease and improvement of lung function. There are lower recurrence and fairly security.