氧驱动高剂量异丙托品雾化吸入治疗慢性阻塞性肺疾病急性恶化的研究

Study of high-dose nebulized ipratropium driven by oxygen for the treatment of patients with exacerbation of COPD

目的 观察和比较氧驱动高剂量异丙托品雾化吸入对慢性阻塞性肺疾病 (COPD)急性恶化的疗效和安全性。方法 3 2例住院COPD急性恶化患者随机均分为对照组 (异丙托品常规剂量吸入 ,每次吸入剂量 40μg ,每日 3次 )和治疗组 (高剂量异丙托品雾化吸入 ,每次吸入剂量 5 0 0 μg ,每日 3次 )。记录治疗前和治疗后0 .2 5、0 .5、1、2、4、6h和 1周时的肺功能、动脉血压、症状和用药反应 ,统计两组恶化持续天数。结果 两组在治疗后 0 .2 5、0 .5、1、2、4、6h一秒钟用力呼气量 (FEV1 )均显著升高 (P <0 .0 5 ) ,治疗组治疗后 0 .2 5hFEV1 为1.2 7L ,0 .5h为 1.40L ,1h为 1.3 8L ,2h为 1.3 0L ,6h为 0 .2 5L ,对照组相应为 1.17、1.2 2、1.2 8、1.2 3、1.16和 1.14L。用药后治疗组 0 .2 5、0 .5、1、2、4及 6h的FEV1 值增高均大于对照组 (P <0 .0 5 )。此外 ,两组用药 1周后 ,肺功能和动脉血气均明显改善 ,但治疗组较对照组更明显 (P <0 .0 5 )。治疗组平均恶化持续天数和住院天数均较短 ,分别为 10 .5d和 11.4d ;对照组较长 ,分别为 15 .7d和 16.4d ,两组用药后的不良反应均少而轻微 ,且差异无显著性。结论 氧驱动高剂量异丙托品雾化吸入治疗COPD急性恶化较常规剂量吸入异丙托品效果更显著 ,其扩张气道明显 ,

Objective To determine and compare the efficacy and safety of high dose nebuliged ipratropium driven by oxygen in patients with exacerbation of COPD. Methods 32 cases with acute exacerbation of COPD admitted to our medical ward were ramdomly assigned to control group (ipratropium delivered via MDIs, n =16, 40 μg, 3 times a day)and treatment group(ipratropium nebuliged with oxygen, n =16, 500 μg, 3 times a day).Pulmonary function test, blood gas analysis, symptoms and responses to the medication were performed and recorded as baseline before treatment and at 0.25,0.5,1,2,4,6 h and one week after treatment. The hospital days and the days of persistent exacerbation of individuals in both groups were recorded. Results FEV 1(L) at 0.25, 0.5, 1, 2, 4 and 6 h after treatment increased significantly( P <0.05), but more significantly improved in the treatment group than in the control group( P <0.05). In addition, pulmonary function and arterial blood gases were improved significantly in both groups after a week of administration but in the treatment group the improvement was more obvious( P <0.05), the average exacerbation lasting days and hospitalization days were shorter (10.5 days and 11.4 days respectively), yet in the control group they were 15.7 and 16.4 days respectively. Side effects were few and mild in both groups and they were not obviously different. Conclusion Compare to the routine dose inhalation, oxygen driving high dose ipratropium by aerosol inhalation is more effective and obvious with stronger bronchodilalation, more persistent and no added adverse effects on acute exacerbation of COPD, particularly good for the patients with severe airway obstruction.