噻托溴铵联合沙美特罗替卡松治疗中重度慢性阻塞性肺疾病的临床效果

牟照红　李小娟　贾刚

[摘要] 目的 探讨噻托溴铵联合沙美特罗替卡松治疗中重度慢性阻塞性肺疾病（COPD）的临床效果。 方法 选取本院2014年1月～2015年1月收治的60例中重度COPD患者作为研究对象，依据治疗药物的不同分为观察组和对照组，各30例。两组均给予常规对症支持治疗。对照组给予沙美特罗替卡松粉吸入剂，观察组在对照组的基础上给予噻托溴铵粉吸入剂。两组均治疗12周。比较两组治疗前后的第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）、第1秒用力呼气容积占预计值百分比（FEV1%）、氧分压（PaO2）和二氧化碳分压（PaCO2）水平及临床疗效。 结果 观察组治疗后的FEV1、FVC、FEV1/FVC、FEV1%水平显著高于对照组治疗后，差异有统计学意义（P<0.05）。观察组治疗后的PaO2水平显著高于对照组治疗后，PaCO2水平显著低于对照组治疗后，差异有统计学意义（P<0.05）。观察组的总有效率为100.0%，显著高于对照组的90.0%，差异有统计学意义（P<0.05）。 结论 噻托溴铵联合沙美特罗替卡松粉吸入剂治疗能够改善COPD患者的肺功能及氧气供应水平，值得临床推广应用。

[关键词] 慢性阻塞性肺疾病；噻托溴铵；沙美特罗替卡松

[中图分类号] R563.9 [文献标识码] A [文章编号] 1674-4721（2016）02（c）-0087-04

[Abstract] Objective To explore the clinical effect of tiotropium bromide combined with salmeterol and fluticas in the treatment of moderate-severe moderate-severe chronic obstructive pulmonary disease （COPD）. Methods 60 cases of moderate-severe COPD in our hospital from January 2014 to January 2015 were selected and divided into the observation group and the control group according to the different drug therapy，30 cases in each group.All patients were given conventional symptomatic supportive treatment.The control group was given salmeterol and fluticas powder inhalant，the observation group was given tiotropium bromide powder inhalant on the basis of the control group.The two groups were all given 12 weeks treatment.The level of FEV1，FVC，FEV1/FVC，FEV1%，PaO2，PaCO2 before and after treatment and the clinical effect of the two groups was compared. Results The level of FEV1，FVC，FEV1/FVC，FEV1% after treatment in the observation group was higher than that in the control group after treatment，with significant difference （P<0.05）.The level of PaO2 after treatment in the observation group was higher than that in the control group after treatment，the level of PaCO2 after treatment in the observation group was lower than that in the control group after treatment，with significant difference （P<0.05）.The total effective rate in the observation group was 100.0%，which was higher than 90.0% in the control group，with significant difference （P<0.05）. Conclusion Tiotropium bromide combined with salmeterol and fluticas treatment can improve lung function and oxygen supply of COPD patients，it is worthy of clinical promotion and application.

[Key words] Chronic obstructive pulmonary disease；Tiotropium bromide；Salmeterol and fluticas

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是一种常见病、多发病，发病机制复杂，其中多种炎症细胞因子、炎症介质等相互作用所产生的慢性气道炎症被认为是COPD的主要发病机制[1]。反复慢性气道炎症可致气道结构破坏、黏液分泌增加，最终导致气流受限而呈不完全可逆[2]。COPD发病率、死亡率较高，治疗费用昂贵，已成为目前广泛关注的公共卫生问题之一[3]。COPD患者往往采用吸入支气管舒张剂治疗，COPD全球防治倡议推荐3、4级COPD患者应采用长期吸入糖皮质激素治疗[4]。本研究采用噻托溴铵联合沙美特罗替卡松吸入治疗本院的COPD患者，并观察其对肺功能的改善作用，取得了较好的效果。

1 资料与方法