乙酰半胱氨酸联合氨溴索治疗老年慢性阻塞性肺病急性发作期的临床研究

Clinical study on acetylcysteine combined with ambroxol in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨乙酰半胱氨酸泡腾片联合盐酸氨溴索注射液治疗老年慢性阻塞性肺病急性发作期的临床疗效。方法选取2015年9月—2016年12月上海市浦东新区南码头社区卫生服务中心收治的老年慢性阻塞性肺疾病患者84例为研究对象,所有患者按照随机数字表法分为对照组和治疗组,每组各42例。对照组静脉滴注盐酸氨溴索注射液,60 mg加入到5%葡萄糖注射液100 m L中,1次/d。治疗组在对照组基础上温水冲服乙酰半胱氨酸泡腾片,600 mg/次,2次/d。两组患者均连续治疗2周。观察两组的临床疗效,比较两组的血气指标、肺功能和血清细胞因子水平。结果治疗后,对照组和治疗组的总有效率分别为76.19%、92.86%,两组比较差异有统计学意义(P<0.05)。治疗后,两组血氧分压(Pa O2)、1秒用力呼气容积(FEV1)和FEV1/用力肺活量(FVC)水平均显著升高,而动脉血二氧化碳分压(Pa CO2)水平显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)和γ-干扰素(IFN-γ)水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的下降程度明显优于对照组,两组比较差异有统计学意义(P<0.05)。结论乙酰半胱氨酸泡腾片联合盐酸氨溴索注射液治疗老年慢性阻塞性肺病急性发作期具有较好的临床疗效,能改善肺功能,减轻炎症反应,具有一定的临床推广应用价值。

Objective To investigate clinical effect of Acetylcysteine Effervescent Tablets combined with Ambroxol Hydrochloride Injection in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease.Methods Patients （84 cases） with cerebral infarction in Shanghai Pudong New Area South Pier Community Health Service Center from September 2015 to December 2016 were randomly divided into control and treatment groups, and each group had 42 cases. Patients in the control group were iv administered with Ambroxol Hydrochloride Injection, 60 mg added into 5% glucose solution 100 mL, once daily. Patients in the treatment group werepo administered with Acetylcysteine Effervescent Tablets on the basis of the control group, 600 mg/time, twice daily. Patients in two groups were treated for two weeks. After treatment, the clinical efficacies were evaluated, and blood gas indexes, pulmonary function, and serum cytokines in two groups were compared.Results After treatment, the clinical efficacies in the control and treatment groups were 76.19% and 92.86%, respectively, and there was difference between two groups （P 〈 0.05）. After treatment, the levels of PaO2, FEV1, and FEV1/FVC in two groups were significantly increased, but the levels of PaCO2 in two groups were significantly decreased, and the difference was statistically significant in the same group （P〈0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups （P〈0.05）. After treatment, the levels of CRP, TNF-α, and IFN-γ in two groups were significantly decreased, and the difference was statistically significant in the same group （P〈0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups （P〈0.05）.Conclusion Acetylcysteine Effervescent Tablets combined with Ambroxol Hydrochloride Injection has clinical curative effect in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease, can improve pulmonary function, and reduce inflammatory reaction, which has a certain clinical application value.