布地奈德福莫特罗粉吸入剂对胸腔镜肺切除术后患者咳嗽和肺功能的影响

Effect of budesonide-formoterol inhalation powder on cough and lung function in patients after thoracoscopic pulmonary resection

目的探究便携式布地奈德福莫特罗粉吸入剂对胸腔镜肺切除术后患者咳嗽和肺功能的影响。方法本研究为非随机对照试验,采用非随机抽样的方法选取2022年12月至2023年5月于河南省人民医院胸外科行胸腔镜肺切除术的188例患者为研究对象。根据术后布地奈德福莫特罗粉吸入剂的用药情况,将术后1周内自行停药的患者纳入对照组(92例),术后持续用药4周及以上的患者纳入病例组(96例)。收集患者的基本特征包括性别、年龄、身体质量指数、体表面积、吸烟史、术后吸烟人数、手术切除类型、手术时长和术后体力活动等级。比较2组患者术前1周和术后1个月时中文版莱斯特咳嗽问卷(LCQ-MC)评分的差异,以及术前、术后LCQ-MC评分的差异。比较2组患者术后LCQ-MC评分下降值和肺功能指标下降率的差异。结果2组患者性别、年龄、身体质量指数、体表面积、吸烟史、术后吸烟人数、手术切除类型、手术时长和术后体力活动等级比较,差异均无统计学意义(均P>0.05)。2组患者术前1周LCQ-MC评分比较差异无统计学意义(Z=1.17,P=0.241),病例组术后1个月时LCQ-MC评分高于对照组[18.66(18.25,19.21)分比16.79(16.22,17.15)分,Z=11.08,P<0.001]。病例组和对照组术后1个月时LCQ-MC评分均低于术前1周[18.66(18.25,19.21)分比20.03(19.15,20.48)分,16.79(16.22,17.15)分比20.17(19.85,20.46)分,Z值分别为8.16、8.33,均P<0.001],对照组患者术后LCQ-MC评分下降值高于病例组[3.30(2.98,3.73)分比1.32(1.03,1.66)分,Z=11.57,P<0.001]。病例组第1秒用力呼气容积下降率、用力肺活量下降率、第1秒用力呼气容积/用力肺活量下降率、呼气流量峰值下降率、最大自主通气量下降率、最大呼气中期流量下降率和肺一氧化碳弥散量下降率均低于对照组[(7.45±9.03)%比(24.73±8.98)%,(8.70±9.02)%比(22.24±9.84)%,-0.77(-6.09,1.19)%比3.50(-0.35,7.12)%,(4.48±11.46)%比(16.68±11.63)%,2.67(-12.20,11.64)%比14.97(4.64,22.49)%,(6.72±21.88)%比(30.49±18.15)%,10.89(3.32,18.37)%比18.07(8.80,24.42)%],而残气量/肺总量下降率高于对照组[2.91(-5.40,8.86)%比-9.32(-16.80,-1.29)%],差异均有统计学意义(均P<0.001)。结论便携式布地奈德福莫特罗粉吸入剂能够改善胸腔镜肺切除术后患者的咳嗽症状并促进肺功能康复。

ObjectiveTo explore the effect of portable budesonide-formoterol inhalation powder on cough and lung function in patients after thoracoscopic pulmonary resection.MethodsIt was a non-randomized controlled trial.One hundred and eighty-eight patients who underwent thoracoscopic pulmonary resection at the Department of Thoracic Surgery in Henan Provincial People′s Hospital between December 2022 and May 2023 were enrolled using the non-random sampling method.According to the post-operative use of portable budesonide-formoterol inhalation powder,patients with self-withdrawal within a week postoperatively were included in the control group(n=92),and those with a continuous medication for a minimum of 4 weeks were included in the case group(n=96).Baseline characteristics,including gender,age,body mass index(BMI),body surface area,smoking history,number of postoperative smokers,type of surgical resection,surgical duration,and postoperative physical activity level were recorded.The mandarin Chinese version of the Leicester cough questionnaire(LCQ-MC)scores at 1 week preoperatively and at 1 month postoperatively were compared between the two groups,as well as the differences in the LCQ-MC scores before and after surgery.The declines of postoperative LCQ-MC scores and lung function were compared between the two groups.ResultsThere were no significant differences in the gender,age,BMI,body surface area,smoking history,number of postoperative smokers,type of surgical resection,surgical duration,and postoperative physical activity level between the two groups(all P>0.05).There was no significant difference in the LCQ-MC scores at 1 week preoperatively between the two groups(Z=1.17,P=0.241).However,the LCQ-MC scores at 1 month postoperative were significantly higher in the case group than those of the control group(18.66[18.25,19.21]points vs 16.79[16.22,17.15]points,Z=11.08,P<0.001).The LCQ-MC scores at 1 month postoperatively were significantly reduced in both groups compared to those at 1 week preoperatively(case group:18.66[18.25,19.21]points vs 20.03[19.15,20.48]points;control group:16.79[16.22,17.15]points vs 20.17[19.85,20.46]points;Z=8.16 and 8.33,respectively;both P<0.001).Patients in the control group experienced a higher decline in the LCQ-MC scores than that of the case group(3.30[2.98,3.73]points vs 1.32[1.03,1.66]points,Z=11.57,P<0.001).Patients in the case group showed significantly lower decline rate of forced expiratory volume in one second(FEV 1)([7.45±9.03]%vs[24.73±8.98]%),forced vital capacity(FVC)([8.70±9.02]%vs[22.24±9.84]%),FEV 1/FVC(-0.77[-6.09,1.19]%vs 3.50[-0.35,7.12]%),peak expiratory flow([4.48±11.46]%vs[16.68±11.63]%),maximal voluntary ventilation(2.67[-12.20,11.64]%vs 14.97[4.64,22.49]%),maximal mid-expiratory flow([6.72±21.88]%vs[30.49±18.15]%),and diffusion capacity of carbon monoxide of lung(10.89[3.32,18.37]%vs 18.07[8.80,24.42]%)compared to that of the control group,and a significantly higher decline rate of residual volume/total lung capacity(2.91[-5.40,8.86]%vs-9.32[-16.80,-1.29]%)(all P<0.001).ConclusionsPortable budesonide-formoterol inhalation powder can effectively alleviate cough symptoms and promote pulmonary function recovery in patients following thoracoscopic pulmonary resection.