噻托溴铵对慢性阻塞性肺疾病患者呼吸中枢驱动影响的临床研究

Effect of tiotropium on neural respiratory drive in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(慢阻肺)患者吸入噻托溴铵后呼吸中枢驱动的变化。方法将2017年1—12月广州医科大学附属第一医院门诊的50例稳定期慢阻肺患者随机分为两组,对照组给予基础治疗方案,药物组在基础治疗上加用噻托溴铵18μg,每日1次。治疗前后记录呼吸困难严重程度分级标准(MRC评分)、肺功能测定值,通过多导食道电极管记录静息状态、最大用力吸气时的食道压(Pes)、胃内压(Pga)、膈肌肌电(EMGdi);比较两组间的差异及治疗前后的变化。结果治疗4周后,药物组MRC评分(2.6±0.5对2.1±0.3,P<0.05)较前降低;肺功能指标、Pes、Pga、跨膈压(Pdi)及最大食道压(Pes-max)、最大胃内压(Pga-max)、最大跨膈压(Pdi-max)、膈肌肌电最大值(EMGdi-max)治疗前后差异无统计学意义;而EMGdi治疗前后[(67.7±30.1)μV对(52.0±24.3)μV]、膈肌肌电占最大值百分比(EMGdi%max)治疗前后[(35.7±12.8)%对(27.3±10.4)%]差异均有统计学意义(P<0.05)。对照组前后各指标差异无统计学意义。结论吸入噻托溴铵后,慢阻肺患者的膈肌肌电值降低,反映呼吸中枢驱动的EMGdi可能是一项判断疗效的新指标。

Objective To analyse the effects of tiotropium on neural respiratory drive in patients with chronic obstructive pttlmonary disease （COPD）. Methods Fifty outpatient with stable COPD of the First Affiliated Hospital of Guangzhou Medical University from Jan. 2017 to Dec. 2017 who were randomized into two groups： no treatment （Control group） or inhaled tiotropium 1Bug once daily （medicine group）. Before and 4 weeks after treatment, spirometry was performed and mMRC was assessed. Also, esophageal pressure（Pes）, gastric pressure （Pga）, diaphragmatic EMG （EMGdi） were recorded with multifunctional esophageal catheter at different states （rest and maximal inspiration）. Compare the difference of groups and changes of before and after treatment. Results In medicine group, the score of mMRC （2.6±0.5 vs. 2.1±0.3, P〈0.05） decreased after treatment. 2here were no remarkable changes in spirometry indexes, Pes, Pga, transdiaphragmatic（Pdi）, Pes-max, Pga-max, Pdi-max and EMGdi-max. There was significant difference in EMGdi （67.7±30.1 vs. 52.0±24.3）（μV）, EMGdi%max （35.7± 12.8 vs. 27.3± 10.4）（%） before and after treatment. There was no significant difference in various indexes before and after treatment in control group. Conclusion Tiotropium significantly reduces neural respiratory drive at rest in COPD. EMGdi reflecting neural respiratory drive could be a new index for therapeutic effect.