长期联合吸入异丙托溴胺与沙丁胺醇的老年慢性阻塞性肺疾病患者对支气管扩张剂的反应性观察

目的观察稳定期老年慢性阻塞性肺疾病(COPD)患者长期吸入可必特气雾剂(异丙托溴胺和沙丁胺醇)后,分别测定对可必特、异丙托溴胺及沙丁胺醇的反应性。方法18例老年稳定期COPD患者吸入可必特气雾剂,每次2喷,3次/d,连续治疗12周,并在治疗前后分别应用可必特、异丙托溴胺及沙丁胺醇气雾剂作为支气管舒张剂行支气管舒张试验,在用药前后测定1s用力呼气容积(FEV1.0)及FEV1.0改善率(△FEV1.0)。结果患者在治疗后吸入可必特的△FEV1.0比治疗前下降(P<0.05),同样在治疗后吸入沙丁胺醇的△FEV1.0比治疗前下降(P<0.01),而吸入异丙托溴胺在治疗前后FEV1.0的改善不明显(P>0.05);在治疗前患者吸入可必特的△FEV1.0要比吸入沙丁胺醇及异丙托溴胺高(P<0.01),在治疗后患者吸入可必特后的△FEV1.0仍高于吸入沙丁胺醇(P<0.01),但与吸入异丙托溴胺相比,差异无统计学意义。结论老年稳定期COPD患者长期联用异丙托溴胺与沙丁胺醇,仍可造成其对沙丁胺醇的反应性低下,建议不要长期联用,采用胆碱能拮抗剂治疗老年COPD患者是一理想途径。

A survey about old patients of chronic obstructive pulmonary disease to respond to bronchodilator after long-term inhalation of ipratropium bromide and salbutamol

Objective Observing stable-phased old patients of chronic obstructive pulmonary disease(COPD) to respond to combivent, ipratropium bromide or salbutamol respectively after long-term inhalation of the combivent(ie,ipratropium bromide/ salbutamol).Methods Eighteen stable-phased old patients of chronic obstructive pulmonary disease inhaled combivent aerosol( 2 puffs of ipratropium bromide/salbutamol ter in die).Pretherapy and post-treatment saw the patients receiving the test of bronchodilation with combivent, ipratropium bromide and salbutamol respectively,and checking FEV1. 0 and its improvement rate (△FEV1.0). Results △FEV1.0 of post-treatment was lower than that of pretherapy(P<0.05)when they inhaled combivent, and the result was the same(P<0.01) when the patients inhaled salbutamol,△FEV1.0 didn′t change in pretherapy and post-treatment when the patients inhaled ipratropium bromide (P>0.05),in pretherapy △FEV1. 0 of inhaled combivent was higher than that of inhaled ipratropium bromide or salbutamol (P<0.01),in post-treatment △FEV1. 0 of inhaled combivent was higher than that of inhaled salbutamol (P<0.01),but the difference wasn′t significant between combivent and ipratropium bromide.Conclusion Long-term combinative use of ipratropium bromide and salbutamol to aged stable COPD will decrease the responsiveness of patient to salbutamol.So we suggest long-term combined inhalation of ipratropium bromide and salbutamol is not a good idea, curing stable-phased old patients of COPD with cholinergic antagonist,ipratropium bromide, is a good choice.