噻托溴铵与异丙托溴铵治疗方案对慢性阻塞性肺疾病急性加重期患者的疗效比较

Comparison of the Efficacy of Tiotropium Bromide and Ipratropium Bromide on Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:比较噻托溴铵与异丙托溴铵分别联合无创正压通气(NIPPV)、常规药物对慢性阻塞性肺疾病急性加重期(AECOPD)的效果。方法:选取2018年10月~2019年10月本院收治的86例AECOPD患者作为研究对象,按照完全随机数字表法分为A组(采用噻托溴铵粉雾剂+NIPPV+常规药物治疗)和B组(采用异丙托溴铵气雾剂+NIPPV+常规药物治疗),各43例。比较两组通气支持时间和机械通气率、治疗前和治疗后肺功能[第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、用力肺活量(FVC)、最大呼气流量(PEF)]、运动耐量[6 min步行距离(6 MWD)]、血气分析指标[p H值、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))],以及治疗期间不良反应发生率。结果:两组通气支持时间和机械通气率比较无统计学差异(P>0.05);治疗后,两组FEV_(1)%pred、FVC、PEF、6 MWD、p H、PaO_(2)高于治疗前,且A组高于B组(P<0.05);治疗后,两组PaCO_(2)低于治疗前,且A组低于B组(P<0.05);治疗期间,两组不良反应总发生率比较无统计学差异(P>0.05)。结论:噻托溴铵与异丙托溴铵分别联合NIPPV、常规药物治疗均可缩短AECOPD通气支持时间,降低机械通气率,安全性也相当,但前者对肺功能、运动耐量和血气分析指标的改善效果优于后者。

Objective:To compare the efficacy of tiotropium bromide and ipratropium bromide combined with non-invasive positive pressure ventilation(NIPPV)and conventional drug treatment on acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 86 patients with AECOPD treated in our hospital from October 2018 to October 2019 were selected as the research subjects,who were divided into group A(treated with tiotropium bromide powder for inhalation+NIPPV+conventional drug treatment)and group B(treated with ipratropium bromide aerosol+NIPPV+conventional drug treatment)according to complete random number table method,with 43 cases in each group.Ventilation support time,mechanical ventilation rates,lung function[forced expiratory volume in one second/predicted value ratio(FEV_(1)%pred),forced vital capacity(FVC),peak expiratory flow(PEF)],exercise tolerance[6 minute walking distance(6 MWD)],and blood gas analysis indexes[pH,partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))]before and after treatment and the incidences of adverse reactions during treatment were compared between the two groups.Results:There was no significant difference in ventilation support time and mechanical ventilation rates between the two groups(P>0.05).After treatment,FEV_(1)%pred,FVC,PEF,6 MWD,p H and PaO2 in the two groups were higher than those before treatment,and those in group A were higher than those in group B(P<0.05).After treatment,PaCO2 in the two groups was lower than that before treatment,and that in group A was lower than that in group B(P<0.05).During treatment,there was no significant difference in the incidences of adverse reactions between the two groups(P>0.05).Conclusion:Tiotropium bromide and ipratropium bromide combined with NIPPV and conventional drug treatment can shorten the ventilation support time of AECOPD,reduce the mechanical ventilation rates,and have the same safety,but the improvement efficacy of the former on lung function,exercise tolerance and blood gas analysis indexes is better than the latter.