布地奈德联合异丙托溴铵治疗慢性阻塞性肺疾病的临床研究

Clinical study on budesonide combined with ipratropium bromide in treatment of chronic obstructive pulmonary disease

目的探讨布地奈德气雾剂联合异丙托溴铵吸入溶液治疗慢性阻塞性肺疾病的临床疗效。方法选取2018年1月-2019年1月襄阳市中心医院收治的80例慢性阻塞性肺疾病患者为研究对象,根据随机数表法分为对照组和治疗组,每组各40例。对照组患者雾化吸入异丙托溴铵吸入溶液,40μg/次,3次/d;治疗组患者在对照组治疗10 min后雾化经口吸入布地奈德气雾剂,2 mg/次,2次/d。两组连续治疗14 d。观察两组的临床疗效,比较两组的临床症状缓解时间、血清炎症因子水平、肺功能指标、氧化应激指标。结果治疗后,对照组和治疗组的总有效率分别为75.00%、92.50%,两组比较差异有统计学意义(P<0.05)。治疗后,治疗组咳嗽缓解时间、喘息缓解时间、退热时间、咳脓痰缓解时间、肺啰音消失时间均短于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组患者血清炎症因子水平明显高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC均显著升高,同组治疗前后比较差异有统计学意义(P<0.05)且治疗组患者肺功能指标明显高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者血清丙二醛(MDA)、活性氧(ROS)水平均显著降低,超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPX)水平均显著升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组氧化应激指标水平明显高于对照组,差异有统计学意义(P<0.05)。结论布地奈德气雾剂联合异丙托溴铵吸入溶液治疗慢性阻塞性肺疾病具有较好的临床疗效,能改善肺功能,降低炎性因子水平,抑制氧化应激反应,安全性较好,具有一定的临床推广使用价值。

Objective To explore the efficacy of Budesonide Inhalation Aerosol combined with Ipratropium Bromide Solution for inhalation in treatment of chronic obstructive pulmonary disease. Methods Patients(80 cases) with chronic obstructive pulmonary disease in Xiangyang Central Hospital from January 2018 to January 2019 were randomly divided into control and treatment groups, and each group had 40 cases. Patients in the control group were atomization inhalation administered with Ipratropium Bromide Solution for inhalation, 40 μg/time, three times daily. Patients in the treatment group were atomization inhalation administered with Budesonide Inhalation Aerosol on the basis of the control group, 2 mg/time, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and clinical symptoms remission time, serum levels of inflammatory factors, pulmonary function indexes, and oxidative stress indexes in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 75.00% and 92.50%, and there was difference between two groups(P < 0.05). After treatment, cough relief time, wheezing relief time, antipyretic time, purulent sputum relief time, and lung rale disappearance time in the treatment group were significantly shorter than those in the control group, and there was difference between two groups(P < 0.05). After treatment, the levels of IL-6, IL-8, and TNF-α in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the serum levels of inflammatory factors in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, FEV1, FVC, and FEV1/FVC in two groups were significantly increased(P < 0.05). And the pulmonary function indexes in the treatment group were significantly higher than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of MDA and ROS in two groups were significantly decreased, but the levels of SOD and GSH-PX in two groups were significantly increased, and the difference was statistically significant in the same group(P < 0.05). And the oxidative stress indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Budesonide Inhalation Aerosol combined with Ipratropium Bromide Solution for inhalation has clinical curative effect in treatment of chronic obstructive pulmonary disease, can improve pulmonary function, reduce the level of inflammatory factors, and inhibit oxidative stress, with good safety, which has a certain clinical application value.