沙美特罗替卡松对重度COPD患者的疗效观察

目的观察长期吸入沙美特罗替卡松对稳定期重度COPD患者肺功能、血气指标、TNF-α及生活质量等的影响。方法选取在我院治疗的78例重度COPD患者随机分为对照组39例、试验组39例。对照组口服茶碱缓释胶囊并按需使用短效支扩剂;试验组在此基础上给予沙美特罗替卡松(50/500μg)吸入治疗。对两组治疗1个月、6个月的肺功能指标、血气指标、痰液TNF-α水平及SGRQ评分改善进行统计比较。结果试验组6个月后FEV1及FEV1/FVC较对照组有明显改善;试验组呼吸困难明显改善;治疗后1个月、6个月时试验组的血气、肺功能指标及SGRQ评分结果均优于对照组,而试验组痰液TNF-α水平均低于对照组,有显著性差异(P<0.05)。结论沙美特罗替卡松吸入治疗稳定期重度COPD,能够显著改善肺功能,明显缓解临床症状,显著提高患者生活质量。     

吸入不同剂量沙美特罗/氟替卡松对稳定期COPD的临床疗效分析

目的研究吸入不同剂量的沙美特罗/氟替卡松(舒利迭)对稳定期COPD的临床治疗效果以指导用药。方法选取我院住院的168例稳定期COPD患者作为研究对象随机分为四组。四组患者给予基础治疗稳定病情后,再分别吸入舒利迭50/500μg、舒利迭50/250μg、沙美特罗50μg、丙酸氟替卡松500μg,持续用药8个月,比较治疗前及治疗后患者的肺功能及临床症状。结果治疗后患者肺功能及临床症状好转,舒利迭(50/500μg)组尤为突出。结论舒利迭对稳定期COPD有较好的疗效,能改善患者的肺功能及临床症状,尤以舒利迭(50/500μg)效果显著。     

沙美特罗/氟替卡松吸入剂(舒利迭)在慢性阻塞性肺疾病中的使用情况

目的为进一步规范慢性阻塞性肺疾病患者正确使用沙美特罗/氟替卡松吸入剂。方法采用问卷调查法,对106例慢阻肺患者进行沙美特罗/氟替卡松吸入剂使用情况的调查。结果操作基本正确的68例,正确率为64.15%;操作不正确的38例,错误率为35.85%。常见的错误有使用前未摇匀准纳器(46.23%)、吸药时未用力按下准纳器顶部(29.25%)、吸药前未深呼气(24.53%)、吸药后未屏气或屏气不10秒(22.64%)、吸药时未及时或不正确漱口(20.75%)、吸药时未深吸(19.81%)、口含准纳器时有漏气(10.38%)等。年龄较小及文化程度越高的正确率较高,在医药护指导下使用正确率较高,年龄较大及文化程度较低的患者使用正确率较低。结论沙美特罗/氟替卡松吸入剂在慢阻肺患者中正确使用情况不容乐观,应采取相应措施提高其使用正确率。     

孟鲁司特钠联合沙美特罗/氟替卡松治疗咳嗽变异性哮喘疗效分析

目的比较孟鲁司特钠联合沙美特罗/氟替卡松、沙美特罗/氟替卡松治疗咳嗽变异性哮喘的疗效。方法选择60名咳嗽变异性哮喘患者,随机分成两组：对照组：吸入沙美特罗/氟替卡松（50 ug/250 ug）早晚各1吸,治疗组：联合孟鲁司特钠10mg每晚口服。每组按需吸入沙丁胺醇气雾剂。观察两组病人的临床疗效、不良反应和复发率。结果治疗组临床疗效明显改善,与对照组相比有显著差异性（P〈0.05）。结论孟鲁司特钠联合沙美特罗/氟替卡松治疗咳嗽变异性哮喘疗效明显,值得推广。     

Changes in lung function and health status in patients with COPD treated with tiotropium or salmeterol plus fluticasone

Background and objective: The effects of tiotropium, a long‐acting anticholinergic drug, were compared with those of the combination of salmeterol, a long‐acting β₂‐agonist, and fluticasone, an inhaled corticosteroid, in patients with COPD. Methods: A 4‐month, randomized, open cross‐over study of tiotropium, 18 µg once daily, versus salmeterol, 50 µg, plus fluticasone, 200 µg, twice daily, was conducted in patients with COPD. Efficacy was assessed by spirometry and responses to the St George's Respiratory Questionnaire (SGRQ). After 4 months, patients were asked to select their subsequent therapy and indicate the reasons for their selection. Results: A total of 78 patients completed the study. There were no significant differences in the improvements in FEV₁ or SGRQ scores between the therapies. Similar numbers of patients selected tiotropium (42.3%) and salmeterol plus fluticasone (57.7%). However, those who preferred one of the therapies demonstrated greater improvements in SGRQ scores with that therapy. One subgroup of patients (30.8%) showed greater improvements in dyspnoea and FEV₁ in response to tiotropium, and the other subgroup of patients (35.9%) showed greater improvements in dyspnoea and FEV₁ in response to salmeterol plus fluticasone. Some patients (14.1%) selected salmeterol plus fluticasone because of positive effects on sputum expectoration. Conclusions: The study was unblinded and the results need to be interpreted with caution. However, tiotropium and salmeterol plus fluticasone had similar overall effects on pulmonary function and SGRQ scores in patients with COPD. Responses to the two therapies were heterogeneous, and the patients who showed greater improvements in FEV₁ or SGRQ scores with one of the therapies preferred it for their subsequent treatment.     

沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘疗效分析

目的探讨沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘的临床疗效。方法将116例哮喘患儿随机分入对照组与观察组,给予56例对照组沙美特罗替卡松吸入治疗,60例观察组患者接受沙美特罗替卡松吸入联合顺尔宁口服,疗程12周,比较两组临床疗效及肺功能的改变。结果观察组治疗有效率显著高于对照组(60.0%vs 37.5%,P<0.05);观察组治疗后日间哮喘症状评分及夜间哮喘症状评分均显著低于对照组(P<0.05);观察组肺功能指标FEV1%和PEF预计值%显著优于对照组(P<0.05)。结论沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘可显著提高临床疗效,改善患儿肺功能。     

国产噻托溴铵粉雾剂与沙美特罗替卡松治疗COPD的肺功能观察

目的分析国产噻托溴铵粉雾剂与沙美特罗替卡松治疗COPD的肺功能变化。方法选取48例门诊Ⅱ级中度COPD患者,男28例,女20例,其中单一吸入国产噻托溴铵粉雾剂(天晴速乐,18μg)14例,单一吸入沙美特罗替卡松(舒利迭,50/250μg)34例。用药前、用药后第4周、第8周记录肺功能。结果所有入选患者在用药4周及8周后肺功能均较前改善,噻托溴铵组的第4周FEV1增加值为133.5±11.8 ml,第8周为68.8±22.0 ml,第4周FVC增加值为151.1±55.8 ml,第8周为55.9±19.6 ml;沙美特罗替卡松组第4周FEV1增加值100.6±24.0 ml,第8周为60.1±17.6 ml,第4周FVC增加值为137.5±41.3 ml,第8周为55±22.4 ml。两组FEV1、FVC增加值无统计学差异。结论国产噻托溴铵粉雾剂与沙美特罗替卡松均可在短期内改善COPD患者肺功能,两组各自的FEV1、FVC增加值差异无统计学意义,噻托溴铵组患者依从性逊于沙美特罗替卡松组。     

吸入性布地奈德、丙酸氟替卡松治疗COPD的临床疗效观察

目的观察布地奈德、丙酸氟替卡松雾化吸入治疗COPD的临床疗效。方法将210例COPD患者随机分为:A组68例,B组72例和对照组70例,3组均采用综合治疗。A组沙丁胺醇加用布地奈德雾化吸入治疗;B组沙丁胺醇加用丙酸氟替卡松雾化吸入治疗。观察测定3组患者的临床疗效及住院天数等,随访停药1a为喘息性疾病患病人数及患病率。结果 A、B组住院天数、喘憋持续时间、咳嗽持续时间、哮鸣音持续时间方面明显短于对照组,B组明显优于A组,差异均有统计学意义;B组总有效率100.0%,明显高于对照组94.3%;B组喘息性疾病的发病率9.7%,明显低于对照组34.3%和A组25.0%,差异有统计学意义(P<0.05)。结论糖皮质激素布地奈德、丙酸氟替卡松联合沙丁胺醇雾化吸入治疗COPD具有较好的临床疗效。     

沙美特罗氟替卡松治疗哮喘的临床疗效及对肺功能的影响

目的探讨沙美特罗氟替卡松治疗哮喘的临床疗效及对肺功能的影响。方法将120例哮喘患者随机分为对照组与观察组,每组60例。给予观察组患者沙美特罗氟替卡松吸人,对照组患者接受沙丁胺醇吸人。比较两组临床治疗总有效率、日间哮喘症状评分及治疗前后肺功能的改变。结果观察组与对照组治疗总有效率分别为91．7％和78．3％,差别具有统计学意义（P〈0．05）;治疗后1月～3月,观察组患者日间哮喘症状评分显著低于对照组（P〈0．05）;治疗后3月观察组用力肺活量（FVC）、第一秒末用力呼气量（FEV1）实／预、最大呼气流速（PEF）和最大呼气中段流量（MMEF）显著优于对照组（P〈0．05）。结论沙美特罗氟替卡松治疗哮喘可显著提高临床疗效,改善患者肺功能及预后。     

沙美特罗替卡松及噻托溴铵联合对COPD患者肺功能的的作用探究

目的探究沙美特罗替卡松及噻托溴铵联合治疗对COPD患者肺功能的的作用。方法将我院收治的COPD患者118例随机分为两组,实验组患者59例,联用噻托溴铵吸入剂18μg,1次/d,沙美特罗替卡松(50/250μg)吸入,2次/d。对照组患者59例,吸入沙美特罗替卡松(50/250μg),2次/d。疗程为6个月。观察比较两组患者治疗前后的疗效,FEV1、FEV1占预计值测量及进行呼吸困难分级。结果实验组患者总有效率89.8%(53/59),显著高于对照组患者总有效率76.3%(45/59),差异有统计学意义(P<0.05);治疗后实验组患者肺功能改善结果显著优于对照组患者,差异有统计学意义(P<0.05)。结论沙美特罗替卡松及噻托溴铵联合治疗COPD患者具有良好的临床疗效,可以显著改善患者的肺功能,提高患者的生活质量,值得临床应用。     

噻托溴铵联合沙美特罗替卡松对慢阻肺急性加重期患者免疫功能的影响

目的探究噻托溴铵联合沙美特罗替卡松对慢性阻塞性肺急性加重期患者免疫功能的影响。方法随机选取我院2013年3月至9月收诊的慢阻肺急性加重期患者78例,按其入院先后顺序分为观察组(40例)与对照组(38例)。给予对照组患者噻托溴铵药物治疗;给予观察组患者联合沙美特罗替卡松药物治疗,观察两组患者治疗前后PCT、CRP水平、FEV_1、FVC及FEV_1/FVC值等变化情况。结果经治疗,两组患者PCT及CRP均明显降低且观察组效果明显优于对照组(P0.05);两组患者FEV_1、FEV_1/FVC及FEC预计值较治疗前均明显改善,且观察组效果明显优于对照组,差异显著(P0.05);两组患者PaO_2及PaCO_2水平均明显改善,对照组PaO-_2及PaCO_2水平(64.3±3.8)mm Hg,(54.3±3.8)mm Hg明显低于观察组(74.2±3.6)mm Hg,(47.6±4.4)mm Hg,差异显著(P0.05);两组患者TNF-α与IL-6水平均明显降低,且观察组降低程度明显高于对照组;两组患者不良反应发生率无显著性统计学差异(P0.05)。结论噻托溴铵联合沙美特罗替卡松治疗慢阻肺急性加重期患者,可有效协助患者恢复其肺功能、提高免疫力等,具有良好推广价值。     

Patient-Reported Outcomes among Omalizumab and Salmeterol/Fluticasone Combination Therapy Patients

Background. Some asthma patients remain poorly controlled despite receiving care consistent with treatment guidelines. Objective. This study compared the ability to sleep, work, and participate in leisure activities among subjects with immunoglobulin E–mediated (allergic) asthma initiating omalizumab (omalizumab start group) with subjects receiving moderate-to-high doses of salmeterol/fluticasone combination therapy, who continued on salmeterol/fluticasone combination therapy for at least a year without adding omalizumab (salmeterol/fluticasone combination continuation group). Methods. Subjects completed an Internet-based screener and, if eligible, an Internet-based questionnaire. A propensity score model was utilized in the analysis. Group differences were assessed through logistic and linear regression models. Analyses were adjusted for propensity score quintile, how subjects heard about the study, and responses to retrospective single-item questions. Results. The analysis population included 86 omalizumab start group subjects and 436 salmeterol/fluticasone combination continuation subjects, recruited from June to November 2006. In the adjusted analyses, the omalizumab start group was more than twice as likely to have controlled asthma as measured by the Asthma Control Test (odds ratio, 2.62; p = 0.005). The omalizumab start group had significantly fewer sleep disturbances as measured by the Jenkins Sleep Evaluation Questionnaire (least-square means difference, ?1.65;p = 0.004), less activity impairment as measured by the Work Productivity Activity Impairment-Asthma Scale (least-square means difference, ?13.36;p < 0.001), and less difficulty in activities as measured by the Valued Life Activities Questionnaire (least-square means difference, ?0.24; p < 0.001). Conclusion. Asthma subjects who started taking omalizumab reported more improvement in asthma control, fewer sleep problems, less activity impairment, and less difficulty with activities than a similar cohort of subjects who continued taking salmeterol/fluticasone combination therapy.     

噻托溴铵联合沙美特罗/丙酸氟替卡松治疗稳定期COPD的临床效果

目的探讨噻托溴铵联合沙美特罗/丙酸氟替卡松联合治疗稳定期慢性阻塞性肺疾病(COPD)的临床效果。方法采用随机的方法将93例稳定期COPD患者分为观察组(47例)和对照组(46例),两组均予常规基础治疗,观察组给予沙美特罗/丙酸氟替卡松(50μg/500μg,2次/d)联合噻托溴铵(18μg,1次/d)吸入治疗,对照组给予沙美特罗/丙酸氟替卡松(50μg/500μg,2次/d)单独吸入治疗,疗程为9个月。观察患者治疗前与治疗后12、24、36周运动耐量、呼吸困难评分以及肺功能的变化。结果治疗后两组患者6min步行距离(6MWD)值、肺功能均有显著增加(P0.05),呼吸困难评分(MRC)均有显著下降(P0.05),而观察组各项指标改善明显优于对照组(P0.05)。结论沙美特罗/丙酸氟替卡松单用可有效缓解稳定期COPD患者的临床症状、改善肺功能。而沙美特罗/丙酸氟替卡松联合噻托溴铵在减轻患者临床症状,改善肺功能上的作用更为显著,值得临床推广应用。     

沙美特罗/氟替卡松联合孟鲁斯特钠治疗咳嗽变异型哮喘的疗效观察

目的观察沙美特罗/氟替卡松联合孟鲁斯特钠治疗咳嗽变异型哮喘(CVA)的疗效。方法收集我院门诊及住院的CVA患者96例,随机分为A、B、C组。A组给予吸入沙美特罗/氟替卡松粉入剂50μg/250μg早,晚各1次,同时给予孟鲁斯特钠10 mg口服,每天1次;B组给予孟鲁斯特钠10mg口服,每天1次;C组给予沙美特罗/氟替卡松粉入剂50μg/250μg吸入早、晚各一次。三组疗程均为8周。对比三组治疗前后的临床疗效及肺功能改变。结果三组治疗的临床疗效及肺功能均较治疗前有不同程度的改善(P0.05);治疗后三组比较,A组的临床疗效及肺功能改善明显优于B、C两组(P0.05),B组和C组临床疗效及肺功能改善相当,差异无统计学意义。结论沙美特罗/氟替卡松联合孟鲁斯特钠改善CVA的临床症状及肺功能明显,疗效更为显著。     

Fast onset of effect of budesonide/formoterol versus salmeterol/fluticasone and salbutamol in patients with chronic obstructive pulmonary disease and reversible airway obstruction

Background and objectives: Data on the onset of action of COPD medications are lacking. This study compared the onset of bronchodilation following different inhaled therapies in patients with moderate‐to‐severe COPD and reversible airway obstruction. Methods: In this double‐blind, double‐dummy, crossover study, 90 patients (aged ≥40 years; FEV₁ 30–70% predicted) were randomized to a single dose (two inhalations) of budesonide/formoterol 160/4.5 μg, salmeterol/fluticasone 25/250 μg, salbutamol 100 μg or placebo (via pressurized metered‐dose inhalers) on four visits. The primary end‐point was change in FEV₁ 5 min after drug inhalation; secondary end‐points included inspiratory capacity (IC) and perception of onset of effect. Results: Budesonide/formoterol significantly improved FEV₁ at 5 min compared with placebo (P < 0.0001) and salmeterol/fluticasone (P = 0.0001). Significant differences were first observed at 3 min. Onset of effect was similar with budesonide/formoterol and salbutamol. Improvements in FEV₁ following active treatments were superior to placebo after 180 min (all P < 0.0001); both combinations were better than salbutamol at maintaining FEV₁ improvements (P ≤ 0.0001) at 180 min. Active treatments improved IC at 15 and 185 min compared with placebo (P < 0.0001). Maximal IC was greater with budesonide/formoterol than salmeterol/fluticasone (P = 0.0184) at 65 min. Patients reported a positive response to the perceptions of the onset of effect question shortly after receiving active treatments (median time to onset 5 min for active treatments vs 20 min for placebo), with no significant difference between active treatments. Conclusion: Budesonide/formoterol has an onset of bronchodilatory effect in patients with COPD and reversible airway obstruction that is faster than salmeterol/fluticasone and similar to salbutamol.     

沙美特罗丙酸氟替卡松对慢性阻塞性肺疾病患者临床疗效及对免疫功能的影响

目的探讨沙美特罗丙酸氟替卡松治疗慢性阻塞性肺疾病(简称慢阻肺)患者的临床疗效及其对免疫功能的影响。方法将100例慢阻肺患者随机分为观察组和对照组各50例。对照组采用常规治疗,观察组在此基础上给予沙美特罗丙酸氟替卡松吸入治疗。观察两组治疗后21天的临床疗效及治疗前后免疫功能指标变化。结果治疗组的有效率为96.00%明显高于对照组的有效率84.00%,差异有明显的统计学意义(P0.05),并且治疗后观察组CD+3,CD+4和CD+4/CD+8水平明显高于对照组,而CD+8水平明显低于对照组水平,差异有显著的统计学意义(P0.01),而Ig G,Ig A,Ig M水平治疗后两组无明显的统计学差异(P0.05)。结论沙美特罗丙酸氟替卡松治疗慢阻肺疗效确切,可改善患者免疫功能,值的临床推广应用。     

沙美特罗替卡松粉联合噻托溴铵治疗慢性阻塞性肺病稳定期C组患者的临床疗效观察

目的 观察吸入不同剂量沙美特罗替卡松粉（舒利迭）联合噻托溴铵治疗慢性阻塞性肺病（COPD）稳定期C组患者的疗效.方法 门诊选取72例COPD稳定期C组患者,随机分成3组,Ⅰ组单独吸入舒利迭（50μg沙美特罗/500 μg丙酸氟替卡松,2次/日）、Ⅱ组单独吸入噻托溴铵（18μg,1次/日）和Ⅲ组吸入舒利迭（50μg沙美特罗/250 μg丙酸氟替卡松,2次/日）＋噻托溴铵（18μg,1次/日）,共治疗12周.用药前后分别检测患者肺功能,应用改良的英国医学研究委员会呼吸困难量表（mMRC）进行评分、COPD评估测试（CAT）及6分钟步行试验（6MWT）.结果 Ⅰ、Ⅲ组患者肺功能指标、mMRC及CAT评分、6分钟步行距离均较治疗前明显改善（P＜0.05）;Ⅱ组患者肺功能指标改善不明显,6分钟步行距离、mMRC及CAT评分均较前改善（P＜0.05）.结论 沙美特罗替卡松粉（50 μg/250 μg,2次/日）联合噻托溴铵治疗COPD稳定期C组患者疗效确切,治疗风险未增加,值得临床推广.     

沙美特罗氟替卡松对支气管哮喘患者血清IL-21和IgE水平的影响

目的探讨沙美特罗氟替卡松用于支气管哮喘治疗时对患者血清IL-21和Ig E水平的影响。方法采用沙美特罗氟替卡松吸入治疗78例支气管哮喘患者,同时选取45例健康体检人员作为对照组,分别检测支气管哮喘患者治疗前后及对照组人员血清IL-21及Ig E,并进行对比分析。结果 78例支气管哮喘患者总有效率为89.7%(70/78);支气管哮喘组血清IL-21及Ig E水平显著高于对照组(P0.01);治疗3个月后支气管哮喘组血清IL-21及Ig E显著降低(P0.01),但仍显著高于对照组(P0.01)。结论沙美特罗氟替卡松吸入治疗支气管哮喘能够有效降低血清IL-21及Ig E水平,减轻气道炎症反应,进而降低气道高反应性,疗效可靠。     

噻托溴铵联合沙美特罗氟替卡松对重度支气管哮喘疗效观察

目的探讨噻托溴铵联合沙美特罗氟替卡松对重度支气管哮喘的临床疗效,提高患者的生活质量。方法对照组给予大剂量沙美特罗氟替卡松粉吸入剂,观察组给予吸人噻托溴铵粉吸入剂联合中等剂量沙美特罗氟替卡松粉吸入剂。结果观察组治疗总有效率为88.0%,对照组治疗总有效率为62.0%,两组对比差异显著,P<0.05。治疗后两组的肺功能较治疗前均有改善,差异有统计学意义,P<0.05;且观察组较对照组改善更明显,差异有统计学意义,P<0.05。结论噻托溴铵联合沙美特罗氟替卡松改善患者生活质量,减少急性加重发作的次数,值得临床推广。     

丹参注射液联合沙美特罗氟替卡松粉吸入剂治疗放射性肺炎的临床观察

目的观察丹参注射液联合沙美特罗氟替卡松粉吸入剂治疗放射性肺炎（RP）的疗效。方法放射性肺炎病人108例,随机分为两组,治疗组54例丹参注射液250ml,静脉滴入1次/天,同时吸入沙美特罗氟替卡松粉吸入剂,每次2喷,2次/天。对照组54例地塞米松注射液10mg静脉注射,1次/天,同时予头孢他啶注射液2.0g加入生理盐水100ml中静脉滴注,2次/天。两组均治疗14天为一个疗程。疗程结束后复查X线胸片。结果治疗组总有效率79.6%,对照组总有效率55.6%,两组对比,差异有统计学意义（P〈0.05）。随访13个月,治疗组仅19例复发,1例死亡;对照组42例复发,7例死亡。治疗组未见血压血糖升高、二重感染等副反应。结论丹参注射液联合沙美特罗氟替卡松粉吸入剂治疗放射性肺炎疗效肯定,毒副反应小,有较好的临床应用价值。