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目的探讨噻托溴铵联合布地奈德福莫特罗治疗重度慢性阻塞性肺疾病(COPD)稳定期患者的临床价值。方法选取我院2012年1月至2014年1月重度COPD稳定期患者160例,按随机数字表法分为联合治疗组和对照组,每组80例。两组均给予常规治疗,对照组给予吸入布地奈德福莫特罗治疗,联合治疗组给予吸入布地奈德福莫特罗和噻托溴铵治疗,治疗6个月后,观察两组治疗前后呼吸困难量(m MRC评分)、6 min步行距离(6MWT)、血二氧化碳分压(Pa CO2)、动脉氧分压(Pa O2)及肺功能变化,并观察治疗期间的不良反应。结果治疗6个月后,两组m MRC分级均较治疗前下降,但联合治疗组下降更为明显,差异均有统计学意义(P<0.05)。两组6MWT治疗6个月后均较治疗前上升,但联合治疗组上升更为明显,差异均有统计学意义(P<0.05)。治疗6个月后,两组第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、Pa O2和Pa CO2均较治疗前明显升高,差异均有统计学意义(P<0.05),但联合治疗组改善更为明显。两组不良反应主要为口干、口腔溃疡、感染、炎症和排尿困难,两组不良反应发生率比较,差异均无统计学意义(P>0.05),治疗期间患者未出现其他严重不良反应。结论噻托溴铵联合布地奈德福莫特罗治疗重度COPD稳定期患者可显著改善呼吸困难症状,肺功能有所提高,且安全性高,值得推广。
Objective To investigate the clinical value of tiotropium combined with budesonide formoterol in patients with stable chronic obstructive pulmonary disease (COPD). Methods A total of 160 patients with severe COPD in our hospital from January 2012 to January 2014 were selected and randomly divided into combined treatment group and control group according to random number table. Both groups were given routine treatment, the control group was given inhaled budesonide formoterol, the combination group was given inhalation of budesonide formoterol and tiotropium treatment, 6 months after treatment, the two groups were observed before and after treatment Dyspnea (m MRC score), 6 min walking distance (6MWT), PaCO 2, PaO 2 and pulmonary function were measured. The adverse reaction was observed during the treatment. Results After 6 months of treatment, m MRC grading in both groups decreased compared with that before treatment, but the combination therapy group decreased more obviously with significant difference (P <0.05). Both groups 6MWT 6 months after treatment than before treatment increased, but the combination therapy group increased more significantly, the differences were statistically significant (P <0.05). After 6 months of treatment, FEV1, FVC, Pa O2 and Pa CO2 in both groups were significantly higher than those before treatment (P <0.05) ), But the combination therapy group improved more obviously. The two groups of adverse reactions were mainly dry mouth, mouth ulcers, infection, inflammation and dysuria. There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). No other serious adverse reactions occurred during the treatment. Conclusion Tiotropium combined with budesonide formoterol in patients with stable COPD can significantly improve the symptoms of dyspnea, pulmonary function has increased, and high safety, it is worth promoting.