痰热清注射液联合沙美特罗替卡松治疗慢性阻塞性肺疾病急性加重期的临床研究

目的探讨痰热清注射液联合沙美特罗替卡松粉吸入剂治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效。方法选取2014年8月—2016年8月于东台市人民医院治疗的AECOPD患者116例为研究对象,将患者随机分为对照组(58例)和治疗组(58例)。对照组吸入沙美特罗替卡松粉吸入剂,1吸/次,2次/d;治疗组在对照组治疗的基础上静脉滴注痰热清注射液,20 m L加入到5%葡萄糖注射液250 m L中,1次/d。两组患者均连续治疗14 d。观察两组患者的临床疗效,同时比较治疗前后两组的肺功能指标、细胞因子水平、动脉血气指标和生活质量评分。结果治疗后,对照组和治疗组的总有效率分别为77.6%、93.1%,两组比较差异具有统计学意义(P0.05)。治疗后两组患者第一秒用力呼出气容积(FEV_1)、用力肺活量(FVC)、FEV_1/FVC均显著升高,同组治疗前后比较差异具有统计学意义(P0.05),且治疗组患者肺功能指标明显高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血浆D-二聚体(D-D)、血清C-反应蛋白(CRP)、降钙素原(PCT)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05),且治疗组患者细胞因子水平明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血氧分压(p O_2)显著升高,二氧化碳分压(p CO_2)显著降低,同组治疗前后比较差异具有统计学意义(P0.05),且治疗组动脉血气指标明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者慢性阻塞性肺病评估测试量表(CAT)评分均显著下降,同组治疗前后比较差异具有统计学意义(P0.05),且治疗组CAT评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论痰热清注射液联合沙美特罗替卡松粉吸入剂治疗AECOPD患者的疗效显著,能有效改善患者的肺功能、相关细胞因子水平和动脉血气指标,具有一定的临床推广应用价值。

Clinical study on Tanreqing Injection combined with salmeterol xinafoate and fluticasone propionate in treatment of acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the clinical effect of Tanreqing Injection combined with Salmeterol Xinafoate and Fluticasone Propionate Powder for inhalation in treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods Patients (116 cases) with AECOPD in Dongtai People''s Hospital from August 2014 to August 2016 were randomly divided into the control group (58 cases) and treatment group (58 cases). Patients in the control group were inhalation administered with Salmeterol Xinafoate and Fluticasone Propionate Powder for inhalation, 1 suction/time, twice daily. Patients in the treatment group were iv administered with Tanreqing Injection on the basis of the control group, 20 mL added into 5% glucose injection 250 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and the lung function indexes, the cytokine levels, arterial blood gas indexes, and the quality of life scores in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment group were 77.6% and 93.1%, respectively, and there were differences between two groups (P<0.05). After treatment, FEV₁, FVC, and FEV₁/FVC in two groups were significantly increased,and the difference was statistically significant in the same group (P<0.05). And the lung function indexes in the treatment group were significantly higher than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of plasma D-D, serum CRP, and PCT in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the cytokine levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, pO₂ in two groups were significantly increased, but pCO₂ in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the blood gas indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, CAT scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the CAT scores in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Tanreqing Injection combined with Salmeterol Xinafoate and Fluticasone Propionate Powder for inhalation has significant clinical efficacy in treatment of AECOPD, can significantly improve the lung function indexes, related cytokine levels and arterial blood gas indexes, which has a certain clinical application value.