信必可联合盐酸氨溴索对慢性阻塞性肺病急性期患者肺功能和炎症因子的影响

The Influence pulmonary function and inflammatory factors of symbicort combined with ambroxol hydrochloride in the treatment of acute exacerbation of chronic obstructive pulmonary disease

目的探讨信必可联合盐酸氨溴索对慢性阻塞性肺病急性期患者肺功能和炎症因子的影响。方法将2014年6月-2016年5月德清人民医院呼吸内科收治的86例慢性阻塞性肺病急性期患者按照计算机随机数字表法分为对照组43例和试验组43例,对照组静脉滴注盐酸氨溴索注射液60 mg/次,2次/天,试验组在对照组治疗基础上给予吸入信必可2吸/次,3次/d。治疗7 d后观察两组患者的临床疗效和不良反应,肺功能测定仪测定用力肺活量占预测值的百分比（percentage of forced vital capacity,FVC%）、第1秒用力呼气量占预测值的百分比（percentage of forced expiratory volume of 1 seconds,FEV1%）、用力呼气中期流速占预测值的百分比（percentage of mid expiratory flow predicted value,MMF%）、最大通气量占预测值的百分比（percentage of max volume predicted value,MVV%）,并计算第1秒用力呼气量占用力肺活量的百分比（FEV1%/FVC%）,采用ELISA检测血清肿瘤坏死因子α（tumor necrosis factor alpha,TNF-α）、C反应蛋白（C-reactive protein,CRP）和白介素6（interleukin 6,IL-6）水平。结果试验组和对照组的总有效率分别为93.02%（40/43）和74.42%（32/43）,差异有统计学意义（P〈0.05）。治疗后试验组患者的FVC%（2.58±0.25）、FEV1%（1.87±0.15）、MMF%（70.24±5.86）和MVV%（72.43±4.35）均高于对照组（2.21±0.27）、（1.68±0.16）、（63.14±5.68）和（65.12±4.16）,差异有统计学意义（P〈0.05）。试验组患者的血清TNF-α（13.87±4.12）μg/m L、CRP（9.14±3.76）mg/m L和IL-6（76.07±10.14）pg/m L水平均低于对照组（16.56±6.48）μg/m L、（12.46±3.89）mg/m L和（89.55±11.24）pg/m L,差异有统计学意义（P〈0.05）。对照组的不良反应主要为胃部灼热、恶心、呕吐和皮疹,试验组的不良反应主要为心悸、头痛、恶心、皮疹、呕吐,观察组的不良反应发生率23.26%（10/43）与对照组比较18.60%（8/43）,差异无统计学意义。结论信必可联合盐酸氨溴索治疗急性期慢性阻塞性肺病临床疗效明确,可提高患者的肺功能,减轻炎症反应,不良反应较少。

Objective To explore the influence pulmonary function and inflammatory factors of symbicort combined with ambroxol hydrochloride in the treatment of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods 86 patients with AECOPD were divided into control group 43 cases and treatment group 43 cases according to the computer random number table method. The control group was given intravenous injection of ambroxol hydrochloride 60 mg/time,2 times/day,and the treatment group was given inhalation of symbicort 2 inhaling/times,3 times/day on the basis of the control group. After 7 day treatment,the clinical efficacy and adverse reactions of two groups were observed. The percentage of forced vital capacity（FVC%）,percentage of forced expiratory volume of 1 seconds（FEV1 %）,percentage of mid expiratory flow predicted value（MMF%）,percentage of max volume predicted value（MVV%） were measured by pulmonary function test apparatus,and the value of FEV1%/FVC% was calculated. The levels of serum tumor necrosis factor alpha（TNF-α）,c-reactive protein（CRP） and interleukin 6（IL-6） were detected by ELISA. Results The total effective rate of treatment group and control group were 93. 02%（40/43） and 74. 42%（32/43）,the difference was statistically significant（P〈0. 05）. After treatment the FVC%（2. 58 ± 0. 25）,FEV1%（1. 87 ± 0. 15）,MMF%（70. 24 ± 5. 86） and MVV%（72. 43 ± 4. 35） in treatment group were higher than the control group（2. 21 ± 0. 27）,（1. 68 ± 0. 16）,（63. 14 ± 5. 68） and 65. 12 ± 4. 16）,the difference was statistically significant（P〈0. 05）. The levels of serum TNF-α（13. 87 ± 4. 12） μg/m L,CRP（9. 14 ± 3. 76） mg/m Land IL-6（76. 07 ± 10. 14） pg/m L in treatment group were lower than the control group（16. 56 ± 6. 48） μg/m L,（12. 46 ± 3. 89） mg/m L and（89. 55 ± 11. 24） pg/m L,the difference was statistically significant（P〈0. 05）. The adverse reactions were mainly for heartburn,nausea,vomiting and skin rashes in the control group,and the adverse reactions were mainly for heart palpitations,headache,nausea,rashes,vomiting in the treatment group,the incidences of adverse reactions 23. 26%（10/43） in treatment group compared to control group 18. 60%（8/43） was no statistically significant difference. Conclusion The symbicort combined with ambroxol hydrochloride in the treatment of AECOPD have clinical curative effect,can improve the patient＇s lung function,reduce inflammation,have less adverse reactions. It was worthy of clinical popularization and application.