噻托溴铵粉雾剂联合沙美特罗替卡松粉吸入剂治疗慢性阻塞性肺疾病急性加重期伴呼吸衰竭的临床研究

Clinical trial of tiotropium bromide powder inhalation combined with salmeterol xinafoate and fluticasone propionate powder inhalation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure

目的观察噻托溴铵粉雾剂联合沙美特罗替卡松粉吸入剂治疗慢性阻塞性肺疾病(COPD)急性加重期伴呼吸衰竭的临床疗效及安全性。方法将76例COPD急性加重期伴呼吸衰竭患者随机分为对照组38例和试验组38例。对照组予以常规治疗配合呼吸机辅助通气治疗;试验组在对照组治疗的基础上,予以沙美特罗替卡松粉吸入剂每次1吸,bid,吸入治疗+噻托溴铵粉雾剂每次18μg,qd,吸入治疗。2组患者均治疗2周。比较2组患者的临床疗效、动脉血气指标、降钙素原和免疫功能,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为92.11%(35例/38例)和73.68%(28例/38例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组的动脉血氧分压分别为(86.35±7.04)和(77.49±6.85)mm Hg,氧合指数分别为(310.89±29.87)和(281.34±27.53)mm Hg,降钙素原分别为(1.42±0.54)和(1.93±0.61)ng·m L^(-1),肿瘤坏死因子-α分别为(275.49±48.62)和(310.05±54.73)ng·L^(-1),白细胞介素-8分别为(312.62±75.64)和(389.75±78.76)pg·m L^(-1),超敏C-反应蛋白分别为(4.73±2.45)和(8.34±2.53)mg·L^(-1),差异均有统计学意义(均P<0.05)。2组患者治疗期间均未发生药物不良反应。结论噻托溴铵粉雾剂联合沙美特罗替卡松粉吸入剂治疗COPD急性加重期伴呼吸衰竭的临床疗效确切,其能显著降低患者的降钙素原水平,改善患者的血气指标和免疫功能,且安全性较好。

Objective To observe the clinical efficacy and safety of tiotropium bromide powder inhalation combined with salmeterol xinafoate and fluticasone propionate powder inhalation in the treatment of acute exacerbation of chronic obstructive pulmonary disease （COPD） complicated with respiratory failure. Methods Seventy - six patients with acute exacerbation of COPD complicated with respiratory failure were randomly divided into control group and treatment group with 35 cases per group. Control group received routine treatment and ventilatorassisted ventilation treatment. Treatment group received salmeterol xinafoate and fluticasone propionate powder inhalation 1 suction, bid, inhalation treatment ＋tiotropium bromide powder inhalation 18μg, qd, inhalation treatment, on the basis of control group. Two groups were treated for 2 weeks. The clinical efficacy, arterial blood gas indexes, procalcitonin, immune functions and adverse drug reactions were compared between two groups. Results After treatment, the total effective rates of treatment and control groups were 92. 11% （35 cases/38 cases） and 73. 68% （28 cases/38 cases） with significant difference （P 〈0.05 ）. After treatment, the main indexes in treatment and control groups were compared： arterial partial pressure of oxygen were （86.35 ±7.04） and （77.49±6. 85）mmHg, oxygenation index were （310. 89±29. 87） and （281.34 ＋27.53） mmHg, procalcitonin were （ 1.42± 0.54） and （ 1.93± 0.61 ） ng · mL-1, tumor necrosis factor - α were （275.49±48.62） and （310. 05±54. 73）ng· L-1 , interleukin - 8 were （312. 62 ±75.64） and （389. 75 ±78.76） pg · mL- 1, high sensitive C - reactive protein were （4. 73± 2. 45 ） and （ 8.34± 2. 53 ） mg· L - 1, the differences were statistically significant （ all P 〈 0. 05 ）. There were no adverse drug reactions in the two groups during the treatment. Conclusion Tiotropium bromide powder inhalation combined with salmeterol xinafoate and fluticasone propionate powder inhalation has a definitive clinical efficacy and safety in the treatment of acute exacerbation of COPD complicated with respiratory failure, which can significantly reduce the levels of procalcitonin, improve the blood gas indexes and immune function.