噻托溴铵粉吸入剂联合沙美特罗替卡松粉吸入剂对哮喘-慢性阻塞性肺疾病重叠综合征患者肺功能和睡眠质量及心率变异性的影响

Effect of tiotropium bromide combined with salmeterol/fluticasone inhalation on lung function,sleep quality and heart rate variability in patients with asthma-chronic obstructive pulmonary disease overlap syndrome

目的探讨噻托溴铵粉吸入剂联合沙美特罗替卡松粉吸入剂对哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)患者肺功能、睡眠质量及心率变异性的影响。方法选择2015年10月至2018年6月在海南省人民医院进行治疗的ACOS患者94例。依据随机数字表法将患者分为对照组(47例)和观察组(47例)。对照组在常规治疗基础上给予沙美特罗替卡松粉吸入剂治疗;观察组在对照组基础上给予噻托溴铵粉吸入剂治疗。比较2组患者治疗前后肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)和第1秒用力呼气容积占预计值百分比(FEV1%pre)]、睡眠情况[匹兹堡睡眠质量指数量表(PSQI)评分和每晚睡眠时间]、心率变异性[24h正常RR间期标准差(SDNN)、连续5min正常RR间期差值的均方根值(RMSSD)和正常相邻RR间期的差高于50ms的心搏数所占百分比(PNN50)]、治疗效果和不良反应发生情况。结果治疗后,2组患者的FVC、FEV1、FEV1%pre和SDNN、RMSSD和PNN50水平均升高,且观察组各项指标水平均高于对照组[(2.88±0.23)L比(2.61±0.27)L、(2.49±0.21)L比(2.04±0.22)L、(47±5)%比(41±6)%、(139±24)ms比(123±26)ms、(54±12)ms比(48±11)ms、(16.0±2.0)%比(15.0±2.0)%],2组患者的PSQI评分均降低,每晚睡眠时间均增加,且观察组PSQI评分低于对照组[(4.7±1.8)分比(7.7±1.9)分],每晚睡眠时间长于对照组[(7.3±1.1)h比(6.8±1.1)h],差异均有统计学意义(均P<0.05)。治疗后观察组患者治疗效果明显高于对照组,差异有统计学意义(P<0.05)。2组患者治疗过程中口干、恶心、头晕、心动过速发生率比较差异均无统计学意义(均P>0.05)。结论噻托溴铵粉吸入剂联合沙美特罗替卡松粉吸入剂治疗可以改善ACOS患者肺功能,提升其睡眠质量并降低心率变异性。

Objective To explore the effect of tiotropium bromide combined with salmeterol/fluticasone inhalation on lung function,sleep quality and heart rate variability in patients with asthma-chronic obstructive pulmonary disease overlap syndrome(ACOS).Methods A total of 94 patients with ACOS admitted to Hainan General Hospital from October 2015 to June 2018 were randomly divided into control group(n=47)and observation group(n=47).The control group was treated with salmeterol/fluticasone inhalation on the basis of routine treatment.The observation group was treated with tiotropium bromide on the basis of control group.Pulmonary function indexes[forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),percentage of predicted FEV1(FEV1%pre)],sleep condition[Pittsburgh Sleep Quality Index(PSQI)and sleeping time per night],heart rate variability[standard deviation of 24 h normal RR intervals(SDNN),root mean square of successive differences(RMSSD),percentage of adjacent RR intervals with difference of duration greater than 50 ms(PNN50)],therapeutic efficacy and adverse reactions were analyzed.Results After treatment,FVC,FEV1,FEV1%pre,SDNN,RMSSD and PN50 significantly increased and the indexes in observation group were higher than those in control group[(2.88±0.23)L vs(2.61±0.27)L,(2.49±0.21)L vs(2.04±0.22)L,(47±5)%vs(41±6)%,(139±24)ms vs(123±26)ms,(54±12)ms vs(48±11)ms,(16.0±2.0)%vs(15.0±2.0)%](all P<0.05).PSQI score significantly decreased and sleeping time per night significantly increased in both groups;PSQI score in observation group was lower[(4.7±1.8)vs(7.7±1.9)]and sleeping time per night was longer[(7.3±1.1)h vs(6.8±1.1)h](all P<0.05)than those in control group(all P<0.05).The therapeutic effect in observation group was significantly better than that in control group(P<0.05).There was no significant difference in the incidences of xerostomia,nausea,dizziness and tachycardia between groups(all P>0.05).Conclusion Combined tiotropium bromide with salmeterol/fluticasone inhalation treating ACOS can effectively improve lung function,improve sleep quality and reduce heart rate variability.