慢性阻塞性肺疾病患者吸入沙丁胺醇和溴化异丙托品后的肺通气功能改变

目的探讨慢性阻塞性肺疾病（ chronic obstructive pulmonary disease, COPD）患者联合吸入沙丁胺醇、溴化异丙托品与单独吸入沙丁胺醇后的肺功能变化差异。方法采用前瞻性方法研究43例COPD患者联合吸药后的肺通气功能变化，回顺性收集180例COPD患者经典支气管舒张试验数据作为对照，比较两组患者的支气管可逆性差异。结果联合吸药组总体和GOLDⅡ级患者吸药30min后支气管舒张试验阳性率为34．9％和43．5％，显著大于单独吸药组总体和GOLDⅡ级患者的阳性率17．2％和18．4％（P〈0．05）。联合吸药组吸药30min后FEV1改善率≥20．0％和〈10．0％的患者比例差异无统计学意义（P〉0．05），分别为37．2％和39．5％．但单独吸药组FEV1改善率≥20．0％和〈10．0％的患者比例差异有统计学意义（P〈0．001），分别为17．8％和53．9％。两组中FEV1改善率≥20．0％的患者比例差异有统计学意义（Pd0．05）。联合吸药组总体和GOLDⅡ级患者吸药30min后的AFEV1和△FVC显著大于单独吸药组总体和GOLDⅡ级患者吸药后的相应值（P〈0．05）。两组患者的AFEV1与△FVC均呈显著正相关，随COPD严重度增加，其相关性在联合吸药组呈增强趋势，而在单独吸药组呈减弱趋势。结论COPD患者联合吸入沙丁胺醇和溴化异丙托品比单独吸入沙丁胺醇更具有明显的支气管舒张可逆性，并且舒张作用的时效性任联合吸药组更长。

Changes of pulmonary ventilation function after inhalated salbutamol and ipratropium bromide in patients with chronic obstructive pulmonary disease

Objective To investigate the different changes of pulmonary ventilation function after inhaled both salbutamol and ipratropium bromide and after inhaled single salbutamol in patients with chronic obstructive pulmonary disease (COPD).Methods The pulmonary function after inhaled combined bronchodilators in 43 patients with COPD were analyzed by prospective study,and as control,the classic bronchodilation test data of 180 patients with COPD were retrospectively collected.Results The positive rates of hronchodilation test after inhaled combined bronchodilators 30 minutes in combined bronchodilators group and its'GOLD Ⅱ patients were 34.9% and 43.5%,which significantly greater than 17.25% and 18.4% of single bronchodilators group and its GOLD Ⅱ patients (P＜0.05).The percentages of patients whose FEV_1 improvement rate≥20.0% and ＜10.0% were 37.2% and 39.5% after inhaled combined bronchodilators 30 minutes in combined bronchodilators group (P>0.05),while in single bronchodilator group the percentages were respectively 17.8% and 53.9% in same FEV_1 improvement rate ranges (P＜0.05).The percentages of patients in two groups whose FEV_1 improvement rate 20.0% were significantly different each other (P＜0.001).△FEV_1 and △FVC after inhaled combined broncbodilators 30 minutes in combined broncbodilators group and its GOLDⅡ patients were greater than those of single bronchodilator group and its GOLDⅡ patients (P＜0.05).There were significant positive correlation between △FEV_1 and △FVC in two groups,along with the progression of COPD,the correlation gradually strengthened in combined bronchodilators group but gradually weakened in single bronchodilator group.Conclusions The patient with COPD had more obvious bronchial reversibility after inhaled both salbutamol and ipratropium bromide than after inhaled single salbutamol,moreover,the duration of drug effect were longer in combined bronchodilators group patients.