小剂量阿奇霉素联合噻托溴铵治疗老年慢性阻塞性肺疾病的临床疗效观察

Clinical Effect of Low-dose Azithromycin Combined with Tiotropium Bromide in Treating Elderly Patients with Chronic Obstructive Pulmonary Disease

目的观察小剂量阿奇霉素联合噻托溴铵治疗老年慢性阻塞性肺疾病（COPD）的临床疗效。方法选取2012—2014年沧州和平医院收治的老年（60~82岁）COPD患者120例,随机分为对照组和研究组,每组60例。在常规治疗基础上,对照组患者给予噻托溴铵治疗,研究组患者给予小剂量阿奇霉素联合噻托溴铵治疗;两组患者疗程均为1年。比较两组患者临床疗效,治疗前后6分钟步行距离（6MWD）、呼吸困难分级、肺功能指标〔第1秒用力呼气容积（FEV_1）、用力肺活量（FVC）、第1秒用力呼气容积与用力肺活量比值（FEV_1/FVC）〕、焦虑自评量表（SAS）评分及抑郁自评量表（SDS）评分,并观察治疗期间两组患者不良反应发生情况。结果研究组患者临床疗效优于对照组（P〈0.05）。治疗前两组患者6MWD和呼吸困难分级比较,差异无统计学意义（P〉0.05）;治疗后研究组患者6MWD长于对照组,呼吸困难分级低于对照组（P〈0.05）。治疗前两组患者FEV_1、FVC及FEV_1/FVC比较,差异无统计学意义（P〉0.05）;治疗后研究组患者FEV_1、FVC及FEV_1/FVC均高于对照组（P〈0.05）。两组患者治疗前SAS评分及治疗前后SDS评分比较,差异无统计学意义（P〉0.05）;治疗后研究组患者SAS评分低于对照组（P〈0.05）。治疗期间两组患者均未出现明显不良反应。结论小剂量阿奇霉素联合噻托溴铵治疗老年COPD的临床疗效确切,能有效改善患者运动耐量及肺功能,减轻呼吸困难症状,缓解焦虑情绪,且安全性较高。

Objective To observe the clinical effect of low - dose azithromycin combined with tiotropium bromide intreating elderly patients with chronic obstructive pulmonary disease （COPD）. Methods A total of 120 elderly patients withCOPD were selected in Cangzhou Peace Hospital from 2012 to 2014, and they were randomly divided into control group and studygroup, each of 60 cases. Based on conventional treatment, patients of control group received tiotropium bromide, while patientsof study group received low - dose azithromycin combined with tiotropium bromide ; both groups continuously treated for 1year. Clinical effect, 6 - minute walk distance, dyspnea grade, index of pulmonary function （ including FEVj, FVC, F E V j/FVC ） , SAS score and SDS score before and after treatment were compared between the two groups, and the incidence of adversereactions during treatment was observed. Results The clinical effect of study group was statistically significantly better than thatof control group （ P 〈 0. 05 ）. No statistically significant differences of 6 - minute walk distance or dyspnea grade was foundbetween the two groups before treatment （ P 〉 0. 05 ） ; after treatment, 6 - minute walk distance of study group was statisticallysignificantly longer than that of control group, while dyspnea grade of study group was statistically significantly lower than that ofcontrol group （P 〈 0. 05 ）. No statistically significant differences of FEVj , FVC or FEVj/FVC was found between the twogroups before treatment （ P 〉 0. 05 ） , while FEVj , FVC and FEVj/FVC of study group were statistically significantly higher thanthose of control group after treatment （ P 〈 0. 05 ）. No statistically significant differences of SAS score or SDS score was foundbetween the two groups before treatment, nor was SDS score between the two groups after treatment （ P 〉 0. 05 ） , while SAS score of study group was statistically significantly lower than that of control group after treatment （ P 〈 0. 05 ）. No one of the twogroups occurred obvious adverse reactions during the treatment. Conclusion Low - dose azithromycin combined with tiotropiumbromide has certain clinical effect in treating elderly patients with COPD, can effectively improve the exercise tolerance andpulmonary function, relive the dyspnea and anxiety, is relatively safe.