噻托溴铵联合微波治疗慢性阻塞性肺疾病稳定期患者的效果观察

Curative effect of the combination of tiotropium bromide and microwave in treatment of stable chronic obstructive pulmonary disease

目的 探讨噻托溴铵联合微波治疗慢性阻塞性肺疾病(COPD)稳定期患者的效果.方法 选取我院门诊2012年7月至2014年3月稳定期COPD患者86例,应用随机双盲法分为两组,观察组给予吸入噻托溴铵1粒/d,并在家或门诊微波(TB-1-A,家用脉冲型)治疗双肺、1次/d、20 min/次;对照组给予吸入噻托溴铵1粒/d,并吸入布地奈德福莫特罗(160 μg/4.5μg)2吸/次、2次/d.治疗时间均为6个月,分别比较两组患者治疗前后1秒用力呼气容积(FEV1)、1秒用力呼气容积占用力肺活量百分比(FEV1/FVC％)、6min步行距离、呼吸困难评分以及肺炎和不良反应发生率.结果 对照组治疗前与治疗6个月FEV1分别为(1.52±0.11)L与(1.86±0.13)L,FEV1/FVC分别为(45.87±3.86)％与(52.34±3.68)％,6 min步行距离分别为(88.0±7.6)m与(240.0±5.8)m,呼吸困难评分分别为(2.4±0.4)分与(1.9±0.3)分,差异均有统计学意义(t值分别为14.60、15.63、18.63、4.96,P均＜0.05);观察组治疗前与治疗6个月FEV1分别为(1.53±0.12)L与(1.84±0.11)L,FEV1/FVC分别为(46.03±3.26)％与(52.96±3.58)％,6 min步行距离分别为(90.0±5.6)m与(231.0±6.3)m,呼吸困难评分分别为(2.3±0.5)分与(1.7±0.4)分,差异均有统计学意义(t值分别为13.78、14.76、12.34、3.15,P均＜0.05).对照组与观察组肺功能、6 min步行距离、呼吸困难评分改善程度比较差异均无统计学意义(P均＞0.05).治疗期间观察组发生肺炎2例(4.65％),对照组5例(11.63％),差异有统计学意义(x2=2.21,P=0.03).治疗6个月对照组的经济费用为(5902±78)元/人,观察组为(4 276±63)元/人,差异有统计学意义(t=18.70,P=0.01).结论 采用噻托溴铵联合微波治疗COPD可有效改善患者肺功能、临床症状及运动耐力;疗效可能接近噻托溴铵联合布地奈德福莫特罗组,但不增加肺炎发生率,且价格低廉,值得临床推广使用.

Objective To investigate the effect of tiotropium bromide inhalant(Spiriva) with microwave therapy in patients with chronic obstructive pulmonary disease (COPD) at stability stage.Methods Eignty-six stable stage COPD outpatients of the People's Hospital of Jiangmen from July 2012 to March 2014 were randomly divided into observation group and control group.Patients in the observation group were given inhaled Spiriva 1 grain/day and home or outpatient microwave (TB-1-A,household type pulse) treatment of double lung 1 time/ day,20 min/time.Patients in control group were given inhaled Spiriva 1 grain/day and inhaled budesonide/ Formoterol(160 μg/4.5 μg) 2 inhaled/time,2 times/day.Before and after treatment,forced expiratory volume in 1 second (FEV1),(FEV1/Forced vital capacity (FVC)) ％,6 min walking distance,dyspnea score,pneumonia cases,adverse reactions were recorded.Results Pulmonary function (FEV1 (L),FEV 1/FVC (％)),6 min walking distance(meter),dyspnea score in control group before treatment,were (1.52±0.11) L,(45.87 ±3.86) ％,(88.0± 7.6) m,(2.4 ± 0.4),significantly different from those after treatment ((1.86 ± 0.13) L,(52.34± 3.68)％,(240.0±5.8) m,(1.9 ± 0.3);t =14.60,15.63,18.63,4.96;P＜ 0.05).Meanwhile,those FEV 1,FEV 1/FVC％,6 min walking distance,dyspnea score,pneumonia cases,adverse reactions in observation group before treatment were (1.53 ± 0.12) L,(46.03 ± 3.26) ％,(90.0 ± 5.6) m,(2.3 ± 0.5),significantly different from those after treatment ((1.84 ± 0.11) L,(52.96 ± 3.58) ％,(231.0 ± 6.3) m,(1.7 ± 0.4);t =13.78,14.76,12.34,3.15;P＜0.05).There were no significant differences between two group in terms of pulmonary function,6 min walk test,dyspnea score(P＞0.05).During treatment,2 cases pneumonia occurred (4.65％) in observation and 5 cases in control group(11.63％).The difference was statistically significant (x2 =2.21,P =0.03).Cost of observation group was (4 276±63)yuan/patients,lower than that in the control group (5 902±78) yuan/patients,and the difference was significant (t =18.70,P =0.01).Conclusion Thiamethoxam bromide with microwave therapy can effectively improve lung function,clinical symptoms and movement endurance in patients with COPD.Curative effect is likely to be close to thiamethoxam and bromine,and with less chance of developing pneumonia.Meanwhile,the hospital cost is lower.So it is worthy of clinical promotion.