复方鲜竹沥液联合复方异丙托溴铵用于慢性阻塞性肺疾病急性加重期的临床研究

Compound Xianzhuliye combined with compound ipratropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨复方鲜竹沥液联合复方异丙托溴铵治疗慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)的临床效果。方法选择浙江普陀医院于2019年12月至2020年12月收治的AECOPD患者160例,依据随机数字表法分为观察组80例与对照组80例。两组患者采取常规治疗。对照组患者给予复方异丙托溴铵治疗,观察组患者在对照组基础上结合复方鲜竹沥液治疗。两组持续治疗14 d。比较两组治疗后疗效,治疗前后血气分析指标[动脉血氧分压(PaO_(2))、氧合指数(OI)和动脉二氧化碳分压(PaCO_(2))]、呼吸力学指标[气道峰压(PIP)、气道阻力(Raw)和平均气道压(mPaw)]、肺功能[第1秒用力呼气容积占预计值百分比(FEV1%)和FEV1/用力肺活量(FVC)]和炎性因子[C反应蛋白(CRP)、白细胞介素6(IL-6)和降钙素原(PCT)]变化。结果观察组患者总有效率(90.00%)高于对照组(76.25%)(χ^(2)=5.391,P<0.05)。观察组治疗后PaO2[(62.17±6.19)mmHg]和OI[(258.83±25.45)mmHg]均高于对照组的(53.86±5.46)mmHg和(210.93±23.12)mmHg,而PaCO2[(46.89±5.25)mmHg]低于对照组的(57.12±4.12)mmHg,差异均有统计意义(t=9.005、12.460、13.711,均P<0.05)。观察组治疗后PIP[(37.87±3.25)cmH2O]高于对照组的(30.82±4.26)cmH2O,而Raw[(6.75±1.82)cmH2O·L^(-1)·s^(-1)]和mPaw[(7.34±1.30)cmH_(2)O]均低于对照组的(9.82±2.10)cmH2O·L^(-1)·s^(-1)和(9.12±1.23)cmH_(2)O,差异均有统计意义(t=11.768、9.881、8.896,均P<0.05)。观察组治疗后FEV1%[(67.31±4.56)%]和FEV1/FVC[(61.23±3.67)%]均高于对照组的(58.98±3.67)%和(52.18±4.68)%(t=12.729、13.610,均P<0.05)。观察组治疗后CRP[(8.86±1.53)mg/L]、IL-6[(65.87±12.90)ng/L]和PCT[(0.15±0.04)μg/L]均低于对照组的(19.90±3.56)mg/L、(109.32±19.76)ng/L和(0.34±0.07)μg/L(t=25.484、16.469、21.079,均P<0.05)。结论复方鲜竹沥液联合复方异丙托溴铵治疗AECOPD可取得良好临床疗效,可改善患者血气分析、呼吸力学指标和肺功能以及可减轻患者炎性反应。

Objective To investigate the clinical effect of compound Xianzhuliye combined with compound ipratropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease.Methods 160 patients with acute exacerbation of chronic obstructive pulmonary disease who received treatment in Zhejiang Putuo Hospital from December 2019 to December 2020 were included in this study.They were randomly assigned to receive either routine treatment combined with compound ipratropium bromide(control group,n=80)or routine treatment,compound ipratropium bromide and compound Xianzhuliye in combination(observation group,n=80)for 14 successive days.Curative effects,blood gas analysis indexes(arterial partial pressure of oxygen,oxygenation index and arterial partial pressure of carbon dioxide),respiratory mechanics indexes(peak airway pressure,airway resistance and mean airway pressure),changes in lung function[percentage of predicted forced expiratory volume in 1 second forced expiratory volume in one second(FEV1%),FEV1/forced vital capacity],inflammatory factors(C-reactive protein,interleukin-6 and procalcitonin)before and after treatment were compared between the control and observation groups.Results Total effective rate in the observation group was significantly higher than that in the control group[90.00%vs.76.25%,χ^(2)=5.391,P<0.05].After treatment,arterial partial pressure of oxygen and oxygenation index in the observation group were(62.17±6.19)mmHg and(258.83±25.45)mmHg,respectively,which were significantly higher than those in the control group[(53.86±5.46)mmHg,(210.93±23.12)mmHg,t=9.005,12.460,both P<0.05].After treatment,arterial partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group[(46.89±5.25)mmHg vs.(57.12±4.12)mmHg,t=13.711,P<0.05].After treatment,peak airway pressure in the observation group was significantly higher than that in the control group[(37.87±3.25)cmH_(2)O vs.(30.82±4.26)cmH_(2)O,t=11.768,P<0.05].After treatment,airway resistance and mean airway pressure in the observation group were(6.75±1.82)cm H_(2)O/L/s and(7.34±1.30)cm H_(2)O,respectively,which were significantly lower than those in the control group[(9.82±2.10)cm H_(2)O/L/s and(9.12±1.23)cm H_(2)O,t=9.881,8.896,both P<0.05).After treatment,FEV1%,FEV1/forced vital capacity in the observation group were(67.31±4.56)%and(61.23±3.67)%,respectively,which were significantly higher than those in the control group[(58.98±3.67)%,(52.18±4.68)%,t=12.729,13.610,both P<0.05).After treatment,C-reactive protein,interleukin-6 and procalcitonin in the observation group were(8.86±1.53)mg/L,(65.87±12.90)ng/L and(0.15±0.04)μg/L,respectively,which were significantly lower than those in the control group[(19.90±3.56)mg/L,(109.32±19.76)ng/L and(0.34±0.07)μg/L,t=25.484,16.469,21.079,all P<0.05).Conclusion Compound Xianzhuliye combined with compound ipratropium bromide in the treatment of acute exacerbation of chronic obstructive pulmonary disease can acquire good clinical curative effects through improving blood gas analysis indexes,respiratory mechanics indexes and lung function,and reduce inflammatory reactions.