双水平气道正压通气联合噻托溴铵对慢性阻塞性肺病急性加重期的疗效观察

Clinical effects of Bi PAP combined with tiotropium bromide in the treatment of chronic obstructive pulmonary disease with acute exacerbation

目的观察双水平气道正压通气(Bi PAP)联合噻托溴铵吸入剂对慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效。方法 60例AECOPD患者按治疗意愿被分成A、B 2组,每组30例。2组均常规给予吸氧、解痉平喘、祛痰、抗感染等治疗;A组同时给予Bi PAP通气;B组给予Bi PAP通气联合噻托溴铵吸入剂18μg,1吸/d。观察患者临床症状、肺功能、血气分析等改善情况及不良反应、平均住院天数。结果 A组总有效率为73.33%,B组为93.33%,2组比较差异有统计学意义(P<0.05)。2组在治疗后临床症状评分、肺功能及血气分析指标较治疗前均显著改善(P<0.05);B组治疗后改善情况明显优于A组,差异有统计学意义(P<0.05)。B组平均住院天数明显少于A组(P<0.05)。B组不良反应发生率低、症状轻微。结论对于AECOPD患者采用Bi PAP通气联合噻托溴铵治疗,其疗效优于单一采用Bi PAP治疗,并且安全、有效,值得临床推广。

Objective To observe the clinical effects of bi-level positive airway pressure（ Bi PAP） combined with tiotropium bromide in the treatment of chronic obstructive pulmonary disease（ AECOPD） with acute exacerbation. Methods Sixty cases of AECOPD with acute exacerbation were randomly divided into group A and group B,each consisting of 30 cases,and clinical analyses were made on them. The patients in both groups were given routine treatment,including oxygen breathing,spasmolysis,expectoration,antiinfection and Bi PAP. At the same time,the patients in group B were administered with the above treatment couple with Bi PAP inhalation agent,with a dosage of 18μg,once a day. Symptoms,pulmonary functions and blood-gas analysis were performed to see the effects and adverse reactions,and hospitalization days were also recorded accordingly. Results Total effective rate for group A was 73. 33%,while the rate for group B was 93. 33%,and statistical differences could be seen,when comparisons were made between them（ P〈0. 05）. Following treatment,symptom scores,pulmonary functions and results of blood gas analysis in the patients of both groups significantly improved,as compared before treatment（ P〈0. 05）. The conditions of the patients in group B were obviously superior to those of the patients in group A,with statistical significance（ P〈0. 05）. For the average length of stay at the hospital,the patients in group B were obviously superior to those of the patients in group A（ P〈0. 05）. The incidence of adverse reactions for the patients in group B was low,with minor symptoms. Conclusion The effects of Bi PAP combined with tiotropium bromide in the treatment of chronic obstructive pulmonary disease with acute exacerbation were obviously superior to that by simple Bi PAP therapy. Furthermore,the former was safer and more effective,which was worth further clinical extension.