噻托溴铵与不同剂量沙美特罗替卡松联合治疗稳定期慢性阻塞性肺疾病的疗效比较

Comparison of the efficacy of tiotropium combined with salmeterol and fluticasone propionate on different specifications of elderly patients with stable chronic obstructive pulmonary disease

目的：比较噻托溴铵与不同剂量沙美特罗替卡松联合治疗老年人稳定期 COPD 的临床疗效。方法选取住院治疗的稳定期中重度 COPD 患者84例，采用数字表法将84例患者随机分为对照组42例和观察组42例，在常规治疗的基础上，两组患者均采用噻托溴铵治疗，对照组联合50μg／250μg 沙美特罗替卡松治疗，观察组联合50μg／500μg 沙美特罗替卡松治疗。两组疗程均为12个月。比较两组治疗后动脉血气、肺功能和运动功能指标及临床疗效的差异。结果治疗12个月后，观察组动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、1秒用力呼气容积（FEV1）、用力肺活量（FVC）、1秒用力呼气容积占用力肺活量百分比（FEV1／FVC）、6 min 步行距离（6 MWD）分别为（51．66±3．96）mmHg、（66．58±4．90）mmHg、（1．39±0．09）L、（2．41±0．09）L、（60．40±4．25）％、（366．01±17．21）m，对照组分别为（46．29±3．38）mmHg、（75．83±5．09）mmHg、（1．59±0．12）L、（2．65±0．10）L、（67．33±4．85）％、（325．69±15．62）m，两组动脉血气、肺功能指标及运动能力均有明显改善，其中，观察组 PaO2明显优于对照组，差异有统计学意义（t ＝6．684，P ＜0．001）；观察组 PaCO2明显优于对照组，差异有统计学意义（t ＝－8．485，P ＜0．001）；观察组 FEV1明显优于对照组，差异有统计学意义（t ＝－8．641，P ＜0．001）；观察组 FVC 明显优于对照组，差异有统计学意义（t ＝－11．561，P ＜0．001）；观察组 FEV1／FVC 明显优于对照组，差异有统计学意义（t ＝－6．964，P ＜0．001）；观察组6 MWD 明显优于对照组，差异有统计学意义（t ＝－11．243，P ＜0．001）。治疗12个月后，观察组总有效率为97．62％，明显优于对照组的85．71％（χ^2＝3．896，P ＝0．048）。结论噻托溴铵联合50μg／500μg 沙美特罗替卡松的综合效果优于噻托溴铵联合50μg／250μg 沙美特罗替卡松。

Objective To compare the curative effect of tiotropium bromide combined with salmeterol flutica-sone of different specifications in treatment of chronic obstructive pulmonary disease（COPD）at stable stage in senile patients.Methods 84 senile patients of COPD were selected.All the patients were divided into observation group （42 cases）and control group（42 cases）.And both groups were provided with basic treatment of tiotropium bromide, on the basic treatment,the patients in the observation group were provided with 50μg/250μg salmeterol fluticasone, and the control group with 50μg/500μg salmeterol fluticasone.The course of treatment in the two groups was 12 months.The arterial blood gas,lung function,motor function and clinical efficacy were compared between the two groups after treatment.Results 12 months after treatment,the arterial oxygen partial pressure（PaO2 ）,arterial carbon dioxide partial pressure（PaCO2 ）,forced expiratory volume in one second（FEV1 ）,forced vital capacity（FVC）,1 second forced expiratory volume accounted for the percentage of forced vital capacity（FEV1 /FVC）of the control group were （51.66 ±3.96）mmHg,（66.58 ±4.90）mmHg,（1.39 ±0.09）L,（2.41 ±0.09）L,（60.40 ±4.25）%,（366.01 ± 17.21）m respectively,which of the observation group were （46.29 ±3.38）mmHg,（75.83 ±5.09）mmHg,（1.59 ± 0.12）L,（2.65 ±0.10）L,（67.33 ±485）%,（325.69 ±15.62）m respectively.The arterial blood gas,lung function and exercise capacity of the two groups were significantly improved,among them,PaO2 of the control group was significantly better than that of the observation group,the difference was statistically significant （t =6.684,P 〈0.001）.PaCO2 of the control group was significantly better than that of the observation group,the difference was statistically significant（t =-8.485,P 〈0.001）.FEV1 of the control group was significantly better than that of the observation group,the difference was statistically significant（t =-8.641,P 〈0.001）.FVC of the control group was significantly better than that of the observation group,the difference was statistically significant（t =-11.561,P 〈0.001）.FEV1 /FVC of the control group was significantly better than that of the observation group,the difference was statistically significant（t =-6.964,P 〈0.001）.6MWD of the control group was significantly better than that of the observation group,the difference was statistically significant（t =-11.243,P 〈0.001）.After 12 months of treatment, the total effective rate of the observation group was 97.62%,which was significantly higher than that of the control group 85.71%（χ^2 =3.896,P =0.048）.Conclusion The comprehensive effect of tiotropium bromide combined with 50μg/500μg salmeterol fluticasone is better than that of tiotropium bromide combined with 50μg/250μg salmeterol fluticasone.