噻托溴铵联合沙美特罗替卡松治疗老年中重度稳定期慢性阻塞性肺疾病的研究

Effect of tiotropium bromide combined with salmeterol on the patients with moderate to severe stable chronic obstructive pulmonary disease in elderly

目的探讨噻托溴铵联合沙美特罗替卡松对老年中重度稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病人的治疗效果。方法选取我院从2016年7月至2017年7月收治的116例老年COPD病人,按随机数字表法随机均分为2组,对照组58例,给予沙美特罗替卡松吸入治疗;观察组58例,在对照组治疗方案的基础上给予噻托溴铵联合治疗。治疗3个月后,比较2组的总有效率、肺功能、慢性阻塞性肺病评估测试(CAT)评分、BODE指数、血清炎性因子等指标的变化,并观察药物的不良反应。结果治疗3个月后,对照组和观察组总有效率分别为68.96%和87.93%,差异具有统计学意义(P<0.05)。2组肺功能均较治疗前有明显改善(P<0.05),且观察组改善明显优于对照组,差异具有统计学意义(P<0.05)。2组CAT评分和BODE指数均较治疗前有明显降低(P<0.05),且观察组比对照组降低更加明显,差异具有统计学意义(P<0.05)。治疗后2组血清炎症因子白介素(IL)-6、IL-12、IL-32及肿瘤坏死因子(TNF-α)均明显降低(P<0.05),且观察组的下降程度均明显高于对照组,差异具有统计学意义(P<0.05)。2组各有5例病人出现口干及咽部不适,不良反应发生率差异无统计学意义(P>0.05)。结论噻托溴铵联合沙美特罗替卡松对中重度稳定期老年COPD病人治疗效果显著,能够有效改善肺功能,减轻炎症反应,从而改善病人长期预后,值得推广应用。

Objective To explore the effect of tiotropium bromide combined with salmeterol on the elderly patients with moderate to severe stable chronic obstructive pulmonary disease（COPD）. Methods A total of 116 cases of COPD from July 2016 to July 2017 hospitalized in our hospital were randomly divided into the control group and the observation group according to random number table method with 58 cases in each group. The control group received salmeterol,while the observation group received tiotropium bromide on the basis of the control group. After the treatment for 3 months,the total effective rate,pulmonary function,CAT score,BODE index,serum inflammatory factors and adverse drug reactions were observed. Results The total effective rates of two groups were 68. 96% and 87. 93% respectively,with significant difference（P〈0. 05）. The pulmonary functions in two groups were significantly better than before（P〈0. 05）,and were much better than those in the control group after treatment（P〈0. 05）. The scores of CAT and BODE index in the observation group were significantly lower than before（P〈 0. 05） in both groups,and especially in the observation group（P 〈0. 05）. The levels of serum inflammatory cytokines including IL-6,IL-12,IL-32 and TNF-α were significantly decreased in both groups（P〈0. 05）,especially in the observation group（P〈0. 05）. There was no significant difference in the incidence of adverse reactions（P〉0. 05）. Conclusions The application of tiotropium bromide combined with salmeterol in patients with moderate and severe COPD shows significant effect, which can effectively improve pulmonary functions,reduce inflammation and improve long-term prognosis.