吸入式异丙托溴铵治疗非小细胞肺癌合并慢性阻塞性肺疾病患者的临床研究

Clinical trial of inhaled ipratropium bromide in the treatment of patients with non-small cell lung cancer combined with chronic obstructive pulmonary disease

目的观察吸入式异丙托溴铵治疗非小细胞肺癌(NSCLC)合并慢性阻塞性肺疾病(COPD)患者的临床疗效及其对肺功能的保护作用。方法回顾性分析本院NSCLC合并COPD患者的临床资料。根据治疗方式不同按照队列法分为对照组和试验组。对照组患者入院后均完善相关检查,进行常规抗感染、吸氧、平喘、氨溴索注射液祛痰等治疗,根据患者病情发展情况可适当给予机械通气支持等,择期进行肺叶切除术。试验组在对照组的基础上给予吸入式异丙托溴铵,雾化吸入用异丙托溴铵溶液500μg,每天2次,连续治疗1周,择期进行肺叶切除术。比较2组患者的临床疗效、肺功能、炎症因子水平以及药物不良反应发生情况。结果对照组入组61例,试验组入组63例。治疗后,试验组和对照组的总有效率分别76.19%(48例/63例)和50.82%(31例/61例),在统计学上差异有统计学意义(P<0.05)。治疗后,试验组和对照组的第1秒用力呼气容积(FEV1)值分别为(1.89±0.61)和(1.57±0.33)L,FEV1占用力肺活量百分比(FEV1/FVC)值分别为(73.36±6.58)%和(63.69±6.21)%,最大呼气流速(PEF)分别为(3.74±0.81)和(3.24±0.50)L·s^(-1),白细胞介素-6(IL-6)分别为(102.51±7.03)和(133.25±7.75)ng·L^(-1),超敏C反应蛋白(hs-CRP)分别为(8.24±2.36)和(18.54±2.31)ng·L^(-1),肿瘤坏死因子-α(TNF-α)分别为(90.36±5.22)和(114.15±5.13)ng·L^(-1),白细胞(WBC)分别为(91.45±9.31)×10^(9)和(121.16±9.88)×10^(9)·L^(-1),在统计学上差异均有统计学意义(均P<0.05)。对照组药物不良反应总发生率分别为4.92%(3例/61例),试验组为7.94%(5例/63例),在统计学上差异无统计学意义(P>0.05)。结论吸入式异丙托溴铵治疗NSCLC合并COPD疗效确切,并对肺功能有保护作用,安全性良好。

Objective To analyze the clinical effect of inhaled ipratropium bromide in the treatment of patients with non-small cell lung cancer(NSCLC)combined with chronic obstructive pulmonary disease(COPD)and its protective effect on lung function.Methods Clinical data of patients with NSCLC complicated with COPD were retrospectively analyzed.According to the different treatment using cohort methods,the patients were divided into control group and treatment group.After admission,the patients in control group completed the relevant examinations,received conventional anti-infection,oxygen inhalation,asthma,ambroxol injection and other comprehensive treatment,and could be given appropriate mechanical ventilation support according to the development of the patient’s condition,and then underwent selective lobectomy.Treatment group inhaled ipratropium bromide treatment:The conventional treatment was the same as control group,combined with atomized ipratropium bromide solution for inhalation 500μg twice a day,continuous treatment for 1 week,and then selective lobectomy was performed.The clinical efficacy,lung function,inflammatory factor levels and adverse drug reactions were compared between the two groups.Results There were 61 cases in control group and 63 cases in treatment group.After treatment,the total clinical effective rate in treatment group and control group were 76.19%(48 cases/63 cases)and 50.82%(31 cases/61 cases),with significant difference(P<0.05).After treatment,the forced expiratory volume in the first second(FEV1)of treatment group and control group were(1.89±0.61)and(1.57±0.33)L;the percentage of FEV1 in forced vital capacity(FEV1/FVC)were(73.36±6.58)%and(63.69±6.21)%;peak expiratory flow(PEF)were(3.74±0.81)and(3.24±0.50)L·s^(-1);interleukin-6(IL-6)were(102.51±7.03)and(133.25±7.75)ng·L^(-1);hypersensitive C-reactive protein(hs-CRP)were(8.24±2.36)and(18.54±2.31)ng·L^(-1);tumor necrosis factor-α(TNF-α)were(90.36±5.22)and(114.15±5.13)ng·L^(-1);white blood cell(WBC)were(91.45±9.31)×10^(9) and(121.16±9.88)×10^(9)·L^(-1);the differences were all statistically significant(all P<0.05).The total incidence of adverse drug reactions was 4.92%(3 cases/61 cases)in control group and 7.94%(5 cases/63 cases)in treatment group,with no statistical significance(P>0.05).Conclusion Inhaled ipratropium bromide is effective in the treatment of NSCLC complicated with COPD,and has protective effect on lung function and good safety.