噻托溴铵治疗COPD的临床疗效观察

目的研究老年性吸烟稳定期COPD应用噻托溴铵的临床疗效。方法分析2009年1月～2011年9月我院收治的90例老年性吸烟稳定期COPD患者,随机分成治疗组和对照组个45例:治疗组(每日给予患者18μg噻托溴铵吸入剂+沙丁胺醇气雾剂);对照组(每隔12小时给予患者口服0.1 g氨茶碱+沙丁胺醇气雾剂),治疗后对患者进行2个月的随访观察,比较两组患者治疗后肺功能的改善情况。结果治疗组经过治疗后St George评分显著降低,优于对照组,并且相对于治疗前FEV1/Pred、FEV1、FEV1/FVC的评分值均有显著提高(P<0.01),对照组治疗效果不明显(P>0.05)。结论噻托溴铵吸入剂联合沙丁胺醇气雾剂可以显著改善老年性吸烟稳定期COPD患者的肺功能。     

噻托溴铵联合信必可都保治疗稳定期COPD的疗效观察

目的观察噻托溴铵联合信必可都保治疗稳定期慢性阻塞性肺疾病(COPD)的效果。方法将100例稳定期COPD患者按入院顺序半随机分为观察组和对照组,每组50例。对照组给予茶碱缓释片常规口服,必要时给予沙丁胺醇气雾剂雾化治疗;观察组给予噻托溴铵联合信必可都保雾化治疗,连续治疗2个月。观察两组患者治疗前后肺功能及血气变化情况。结果观察组患者肺功能改善情况及血氧饱和情况明显优于对照组,且均具有统计学意义(P0.05)。结论噻托溴铵联合信必可都保可明显改善稳定期COPD患者的肺功能状态,有利于改善患者预后,提高生活质量。     

噻托溴铵对轻到中度COPD患者疗效观察

目的评价噻托溴铵对轻中度COPD患者的疗效。方法在12周时间内,轻中度COPD患者接受治疗后分别测定其1 d,15 d,85 d噻溴托按组（18 ug qd）和安慰剂组的肺功能（以给药前1 d测定值为基线）。结果两组用药前平均FEV1预计值%为73.4±12.5。试验结束时噻托溴铵组FEV1用药前及用药后2 h曲线下面积（AUC0~2 h）与安慰剂组对照,都有显著提高（P〈0.0001）。两组不良反应相似。结论噻托溴铵较安慰剂显著改善轻度COPD患者肺功能。     

噻托溴铵治疗稳定期慢性阻塞性肺疾病疗效观察

目的评价噻托溴铵治疗稳定期慢性阻塞性肺疾病(COPD)的疗效和安全性。方法将50例年龄40～75岁稳定期Ⅰ、Ⅱ级COPD患者随机分为治疗组和对照组。治疗组吸入噻托溴铵干粉剂(18μg,每日1次)治疗13周。在治疗前,治疗4周及12周分别测定肺功能。结果治疗组第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、FEV1占预计值的百分比上升值较对照组有有显著性差异(P<0.05)。噻托溴铵的常见不良反应为口干(2例,8%),无心血管系统异常和心电图异常报告。结论噻托溴铵对于稳定期Ⅰ、Ⅱ级COPD患者疗效显著且安全可靠。     

噻托溴铵对稳定期COPD患者夜间睡眠低氧的临床疗效

目的观察噻托溴铵对慢性阻塞性肺疾病(COPD)患者夜间睡眠低氧和睡眠质量的疗效。方法 40例存在夜间睡眠低氧的稳定期COPD患者随机分为两组,治疗组吸入噻托溴铵,对照组吸入安慰剂,治疗前后检测夜间血氧饱和度、血气分析、肺功能和匹兹堡睡眠质量指数(PSQI)评分。结果治疗后治疗组夜间平均血氧饱和度、夜间最低血氧饱和度、动脉血氧分压和动脉血氧饱和度较对照组明显升高(均P<0.05),夜间血氧饱和度小于90%的时间占总睡眠时间的百分比和PSQI总分较对照组显著降低(均P<0.01),第1秒用力呼气容积、用力肺活量和深吸气量较对照组显著增加(均P<0.01)。结论噻托溴铵能改善COPD患者夜间睡眠低氧和睡眠质量。     

噻托溴铵治疗慢性阻塞性肺疾病缓解期患者的临床观察

慢性阻塞性肺疾病的远期愈后较差,肺功能逐渐下降,呼吸困难逐渐加重,运动耐量和生活质量亦逐渐下降.我院在治疗慢性阻塞性肺疾病缓解期患者时使用噻托溴铵干粉吸入治疗,使患者的肺功能和运动耐量得到改善.现报道如下.     

噻托溴铵治疗慢性阻塞性肺疾病稳定期的临床疗效研究

目的探讨噻托溴铵治疗慢性阻塞性肺疾病(COPD)稳定期的临床疗效。方法选取2012年在南昌大学第一附属医院进行治疗的COPD稳定期患者200例,随机分为治疗组和对照组,各100例。对照组患者给予COPD常规治疗,治疗组患者在COPD常规治疗基础上给予噻托溴铵治疗,均连续治疗8周后随访6个月。比较两组患者治疗前后肺功能指标,包括:第一秒用力呼气末容积(FEV1)、用力肺活量(FVC)及FEV1/FVC比值;观察两组患者治疗前和随访3、6个月时呼吸困难指数(m MRC)和6分钟步行距离(6MWT)及治疗期间不良反应发生情况。结果两组患者治疗前FEV1、FVC及FEV1/FVC比值比较,差异无统计学意义(P0.05);治疗组患者治疗后FEV1、FVC及FEV1/FVC比值均高于对照组(P0.05)。两组患者治疗前m MRC和6MWT比较,差异无统计学意义(P0.05);治疗组患者随访3个月、6个月时m MRC低于对照组,6MWT长于对照组(P0.05)。治疗组患者不良反应发生率为7%,与对照组的8%比较,差异无统计学意义(P0.05)。结论噻托溴铵能改善COPD稳定期患者肺功能,缓解临床症状,提升运动耐量,且安全性良好。     

噻托溴胺治疗稳定期COPD

目的观察噻托嗅胺对稳定期慢性阻塞性肺疾病（COPD）患者的临床疗效。方法 40例稳定期COPD患者随机分成两组,实验组应用噻托嗅铵18 ug吸入,1次/天,对照组口服茶碱缓释片100 mg,2次/天.观察记录患者治疗前后肺功能、6min步行距离、生活质量评分。结果两组治疗后肺功能、临床症状等较治疗前均有好转,但实验组较对照组FEVl占预计值百分比明显增加,生活质量明显改善,6 min步行距离、临床症状明显改善。两组治疗前后各项指标比较,差异具有统计学意义（P〈0.05或P〈0.01）。结论长期规律吸入噻托溴胺可有效改善慢阻肺患者肺功能并缓解临床症状,提高患者的生活质量。     

老年人稳定期慢阻肺应用噻托溴铵的临床观察

目的探讨老年人COPD稳定期应用噻托溴铵治疗的疗效。方法选取58例慢性阻塞性肺疾病稳定期的患者,并随机分成两组即噻托溴铵组(30例)和异丙托溴铵组(28例),噻托溴铵组给予噻托溴铵治疗,异丙托溴铵组给予异丙托溴铵治疗,两组疗程均为60天,通过观察两组患者临床症状及肺功能改善情况等指标,分析对比两组疗效差别。结果噻托溴铵组的临床症状、肺功能改善情况明显优于异丙托溴铵组相关指标,P<0.05。结论噻托溴铵用于稳定期COPD的治疗效果优于异丙托溴铵。     

噻托溴铵吸入治疗AECOPD的临床观察

目的探讨噻托溴铵治疗AECOPD患者的临床疗效。方法选择78例AECOPD患者,随机分为常规治疗组(对照组)37例和噻托溴铵治疗组(治疗组)41例,治疗组应用噻托嗅铵18μg吸入,1次/天,观察两组患者治疗前后症状、呼吸困难评分及肺功能变化。结果两组有效率达100%,且治疗组较对照组改善更明显,治疗后两组临床症状、呼吸困难评分和肺功能等比较,差异有统计学意义(P<0.05)。结论噻托溴铵吸入治疗AECOPD,能明显缓解患者症状,改善肺功能,是治疗AECO-PD的有效选择。     

沙美特罗替卡松联合噻托溴铵治疗稳定期COPD的临床观察

目的 观察吸入不同剂量沙美特罗替卡松联合噻托溴铵治疗稳定期COPD患者的疗效.方法 门诊选取90例稳定期中-重度度COPD患者,随机分成3组,A组单独吸入噻托溴铵（18 μg 1/日）,B组吸入沙美特罗替卡松（50/250 μg 2/日）＋噻托溴铵（18 μg 1/日）和C组吸入沙美特罗替卡松（50/500 μg 2/日）＋噻托溴铵（18 μg 1/日）,共治疗12周.用药前后分别检测患者肺功能,6分钟步行试验（6MWT）,MMRC评分.结果 A组患者治疗后肺功能、6MWD及MMRC评分均有所好转,但无统计学差异（P＞0.05）;B组中度COPD患者治疗后的肺功能显著改善,6MWT力增加,MMRC评分降低（P＜0.05）;重度患者的疗效均无统计学差异（P＞0.05）;C组患者疗效显著（P＜0.05）,中度患者较B组无更大获益.结论 沙美特罗替卡松（50/250 μg 2/日）联合噻托溴铵（18 μg 1/日）治疗稳定期中度COPD患者疗效确切,且减少患者经济负担和药物副作用.     

The functional impact of adding salmeterol and tiotropium in patients with stable COPD

The aim of this double-blind, double-dummy, crossover, randomised, pilot study was to explore the acute effects of adding salmeterol and tiotropium in patients with stable COPD. A total of 20 outpatients with stable COPD were enrolled. Single doses of 18-microg tiotropium, 50-microg salmeterol, and 18-microg tiotropium+ 50-microg salmeterol were given. Serial measurements of forced expiratory volume in 1 s (FEV1) were performed over 24h. The mean maximum increases in FEV1 from pre-dosing value on each of the dosing days were 0.165l (95% CI: 0.098-0.232) for tiotropium, 0.241 l (95% CI: 0.151-0.332) for salmeterol, and 0.290 l (95% CI: 0.228-0.353) for the combination and occurred 4 h after inhalation of tiotropium or salmeterol and 3 h after the combination. At 12h, the mean increases in FEV1 from pre-dosing value were 0.071 l (95% CI: 0.001-0.141; P = 0.047) for tiotropium, 0.069 l (95% CI: 0.018-0.120; P = 0.010) for salmeterol, and 0.108 l (95% CI: 0.047-0.170; P = 0.001) for the tiotropium + salmeterol combination. Only the difference between salmeterol and tiotropium + salmeterol was statistically significant (P = 0.009). At 24h, the mean FEV1 value was still higher than the mean pre-dosing value for tiotropium (0.042 l; 95% CI: -0.012-0.097; P=0.119) and the tiotropium+salmeterol combination (0.051 l; 95% CI: 0.01 5-0.087; P = 0.007), but not for salmeterol alone (-0.013 l; 95% CI: -0.041-0.014; P = 0.324). The FEV1 area under the curve (AUCs0-12h) were 1.657 l (95% CI: 1.152-2.162) for tiotropium, 2.068 (95l CI: 1.385-2.752) for salmeterol, and 2.541 l (95% CI: 1.954-3.129) for tiotropium + salmeterol. Only the difference between tiotropium and the tiotropium +salmeterol combination was statistically significant (P = 0.01). The FEV1 AUCs0-24h were 2.854 l (95% CI: 1.928-3.780) for tiotropium, 2.786 l (95% CI: 1.913-3.660) for salmeterol, and 3.640 l (95% CI: 2.674-4.605) for tiotropium + salmeterol. ALL differences between treatments were not statistically significant (P> 0.05). These results seem to indicate that the use of the tiotropium + salmeterol combination is more efficacious than the single agents alone, but the once-daily administration of the two drugs is inadvisable due to the broncholytic profile of salmeterol.     

Role of tiotropium in the treatment of COPD

Tiotropium is a potent, long-acting, selective anticholinergic bronchodilator. Treatment with tiotropium produces sustained improvements in lung function, particularly FEV₁ (peak, trough, average, and area under the curve) compared with either placebo or ipratropium in patients with moderate to severe COPD. Preliminary evidence suggests that treatment with tiotropium may slow the rate of decline in FEV₁, but this finding awaits confirmation. Tiotropium reduces lung hyperinflation, with associated improvements in exercise capacity. Tiotropium, compared with either placebo or ipratropium, improves a variety of patient-centered outcomes, including subjective dyspnea ratings and HRQL scores. Tiotropium reduces the frequency of COPD exacerbations and of hospitalizations due to exacerbations, but has not been shown to reduce all-cause mortality. Compared with the long-acting bronchodilators, tiotropium provides incrementally better bronchodilation, but it is not clearly superior in terms of patient-centered outcomes. Tiotropium has a good safety profile; however patients with severe cardiac disease, bladder outlet obstruction, or narrow angle glaucoma were excluded from all studies. Medico economic analyses suggest that treatment with tiotropium may also be cost-effective, primarily by reducing costs associated with hospitalizations.     

噻托溴铵对稳定期慢性阻塞性肺疾病患者血清细胞因子水平及肺功能的影响

目的探讨噻托溴铵对稳定期慢性阻塞性肺疾病(简称慢阻肺)患者肺功能的影响及气道炎症的改善作用。方法选择符合病例选择标准的患者81例,采用随机数字表法分为观察组40例和对照组41例,对照组口服茶碱缓释片,观察组给予噻托溴铵干粉剂,疗程均为16周。治疗前后观察第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、FEV1/预计值以及血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-12(IL-12)变化。结果两组患者治疗前FEV1/FVC、FEV1/预计值比较,差异无统计学意义(P0.05)。治疗16周时,两组患者FEV1/FVC、FEV1/预计值较本组治疗前均明显提高,差异有统计学意义(P0.05),且观察组提高幅度明显大于对照组(P0.05)。两组患者治疗前血清hs-CRP、TNF-α、IL-6及IL-12水平相似,差异无统计学意义(P0.05);治疗16周时,两组血清hs-CRP、TNF-α、IL-6及IL-12水平较本组治疗前均明显降低,差异有统计学意义(P0.05),且观察组降低幅度明显大于对照组(P0.05)。观察组患者不良反应发生率10.00%,对照组不良反应发生率14.63%,差异无统计学意义(P0.05)。结论噻托溴铵治疗善稳定期慢阻肺可显著改善患者肺功能、下调血清hs-CRP、TNF-α、IL-6及IL-12表达,抑制慢性炎性反应,延缓肺功能的减退。     

吸入噻托溴铵联合舒利迭治疗稳定期中重度COPD的临床研究

目的研究吸入噻托溴铵联合舒利迭治疗稳定期中重度慢性阻塞性肺疾病(COPD)的治疗效果。方法 45例稳定期中重度COPD患者(完成实验43例,因病情加重退出实验2例)随机分成两组,治疗组给予噻托溴铵(商品名:思力华)及舒利迭(沙美特罗/氟替卡松)吸入治疗12周,对照组给予舒利迭吸入治疗12周,比较两组治疗前后临床症状、体征、血氧饱和度及肺功能主要指标。结果与对照组比较,治疗组FEV1/FVC以及FEV1占预计值百分比显著提高,临床症状体征及血氧饱和度明显改善(P0.05)。结论吸入噻托溴铵联合舒利迭可有效改善肺功能并缓解临床症状。     

Impairment of small airways in COPD patients with frequent exacerbations and effects of treatment with tiotropium

Disease exacerbations are an important aspect of COPD, because they affect its course and are associated with higher lung function decline. On the other hand, data obtained by biopsies have demonstrated that the progression of COPD is related to an increasing impairment of small airways. We sought to evaluate the small airway impairment (FEF25–75) in two groups of COPD patients (each group had 37 subjects) in relation to the frequency of exacerbations and the effectiveness of treatment with tiotropium bromide on the small airway impairment. The mean number of exacerbations was 3.6/year and 1.38/year in frequent and in infrequent exacerbators, respectively (p < 0.001). The mean value of FEF25–75 at baseline was 624 mL and 865 mL in frequent and in infrequent exacerbators respectively (p = 0.002). The changes in respiratory parameters versus baseline showed increases in mean FEV₁, FVC, and FEF25–75 in both groups but only the increase in FEF25–75 in frequent exacerbators was statistically significantly (p = 0.013). During the 3-month period of the study the mean number of exacerbations was 0.66 in frequent and 0.12 in infrequent exacerbators. These findings indicate that COPD patients with frequent exacerbations have a higher impairment of small airways. Treatment with tiotropium in COPD subjects with frequent exacerbations proved to be effective in improving small airway impairment.     

联合吸入噻托溴铵及沙美特罗替卡松对稳定期COPD患者血清炎症细胞因子及肺功能的影响

目的探讨联合吸入噻托溴铵及沙美特罗替卡松对稳定期重度、极重度COPD患者血浆炎症细胞因子及肺功能的影响。方法选取我院呼吸科门诊就诊的稳定期重度、极重度COPD患者80例,应用完全随机方法将患者分成两组,一组联合应用噻托溴铵及沙美特罗替卡松干粉剂(联合组),一组单用沙美特罗替卡松干粉剂(单药组),共治疗12个月。并分别于治疗前及治疗3个月、6个月、12个月测定患者血清炎症细胞因子(IL-8、TNF-α)及肺功能(FEV1、FVC、IC)。结果两组患者于治疗后各时期血清IL-8、TNF-α较治疗前均有明显下降,肺功能指标均较治疗前明显改善,差异有统计学意义(P<0.05)。结论噻托溴铵与沙美特罗替卡松联合能明显降低稳定期COPD患者IL-8、TNF-α水平,减轻气道炎症,并改善患者的肺功能。     

稳定期COPD并冠心病老年患者应用噻托溴铵治疗的临床研究

目的研究噻托溴铵联用舒利迭(50μg/250μg)治疗稳定期慢性阻塞性肺疾病(COPD)并冠心病(CHD)老年患者的疗效及安全性。方法 65名稳定期的中重度COPD并CHD老年患者随机分观察组33例,对照组32例,对照组吸入舒利迭(50μg/250μg),观察组联合应用噻托溴铵,在治疗前、治疗3月、6月后行肺功能、动态心电图及肝肾功能检测。结果治疗6月后观察组呼吸困难改善,总有效率(90.91%)明显高于对照组(71.88%),P<0.05。两组患者经治疗后肺功能有明显改善(P<0.01),而观察组联合治疗改善作用更显著。两组动态心电图比较差异无统计学意义(P>0.05)。结论舒利迭联合噻托溴铵治疗COPD并CHD老年患者可以明显改善呼吸困难症状及肺功能,安全性好。