布地奈德联合复方异丙托溴铵雾化吸入治疗围术期尘肺病的临床研究

Clinical research of aerosol inhalation of Budesnide combined with Compound Ipratropium Bromide in the treatment of patients with perioperative pneumoconiosis

目的探讨布地奈德联合复方异丙托溴铵雾化吸入治疗围术期尘肺病的临床效果。方法选择广州医科大学附属广州第十二人民医院2014年1月~2017年2月收治的139例尘肺病患者,按随机数字表法将其分为对照组(69例)和治疗组(70例)。两组患者均于全身静脉复合麻醉后给予大容量全肺灌洗(WLL)治疗,治疗组在术前3 d到术后3 d期间在WLL基础上均给予布地奈德联合复方异丙托溴铵雾化吸入治疗。比较两组治疗前3 d和治疗后7 d的临床症状综合评分、肺功能指标和血气指标、痰液中肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)水平,记录并比较两组患者治疗过程中不良反应的发生情况。结果两组治疗后临床症状综合评分明显低于治疗前,用力肺活量(FVC)、第1秒用力呼气容积(FEV1)均明显大于治疗前,且治疗组治疗后临床症状综合评分、FVC、FEV_1变化明显优于对照组,差异均有统计学意义(P<0.05)。两组治疗后血氧分压(PaO_2)明显大于治疗前,动脉血二氧化碳分压(PaCO_2)明显小于治疗前,且治疗组治疗后PaO_2、PaCO_2变化明显优于对照组,差异均有统计学意义(P<0.05)。两组治疗后痰液中TNF-α、IL-1水平均明显低于治疗前,且治疗组治疗后痰液中TNF-α、IL-1水平均明显低于对照组,差异均有统计学意义(P<0.05)。治疗过程中,治疗组低氧血症、气道痉挛、气道压增高等不良反应的发生率均明显低于对照组,差异均有统计学意义(P<0.05)。结论布地奈德联合复方异丙托溴铵雾化吸入辅助治疗给予WLL的尘肺病患者,能够提高WLL的疗效,缓解临床症状,改善患者肺功能和PaO_2,降低痰液中炎症因子水平,减轻不良反应的发生,值得在临床上推广应用。

Objective To investigate the effects of aerosol inhalation of Budesonide combined with Compound Ipratropium Bromide in the treatment of patients with perioperative pneumoconiosis.Methods One hundred and thirty-nine patients with pneumoconiosis admitted to Guangzhou Twelfth People＇s Hospital Affiliated to Guangzhou Medical University from January 2014 to February 2017 were enrolled in this study,and they were divided into control group （69 cases） and treatment group （70 cases） by random number table method.Both groups were treated by whole-lung lavage （WLL） under general anesthesia.The treatment group was treated with aerosol inhalation of Budesnide combined with Compound Ipratropium Bromide during the period of 3 days before treatment and 3 days after treatment.The comprehensive score of clinical symptoms,lung function index,blood gas index and the sputum tumor necrosis factor-α （TNF-α）,interleukin-1 （IL-1） levels of the two groups during the period of 3 days before treatment and 7 days after treatment were compared between the two groups.The adverse reactions during the treatment of the two groups were recorded.Results The comprehensive score of clinical symptoms of the two groups after treatment were significantly lower than those before treatment,the forced vital capacity （FVC）,forced expiratory volume in one second （FEV1） of the two groups after treatment were significantly higher than those before treatment,and the improvement of comprehensive score of clinical symptoms,FVC,FEV1 in the treatment group was significantly better than those of the control group （P 〈 0.05）.The partial pressure of blood oxygen （PaO2） of the two groups after treatment were significantly higher than those before treatment,the arterial partial pressure of carbon dioxide （PaCO2） of the two groups after treatment were significantly lower than those before treatment,and the changes of PaO2,PaCO2 after treatment in the treatment group were significantly better than those of control group,the differences were statistically significant （P 〈 0.05）.The levels of sputum TNF-α,IL-1 in the two groups after treatment were significantly lower than those before treatment,and the levels of sputum TNF-α,IL-1 after treatment in the treatment group were significantly lower than those of the control group （P 〈 0.05）.The incidence of adverse reactions of hyoxemia,airway spasm,airway pressure increasing of the treatment group was significantly lower than that of the control group during the treatment,the difference was statisti cally significant （P 〈 0.05）.Conclusion Aerosol inhalation of Budesonide combined with Compound Ipratropium Bromide in the treatment of patients with pneumoconiosis who were given WLL can improve clinical efficacy of WLL,relieve clinical symptoms,improve pulmonary function and SpOt,decrease the levels of sputum inflammatory factors and reduce the occurrence of adverse reactions,and it is worthy of clinical promotion and application.