联合吸入噻托溴铵和沙美特罗／丙酸氟替卡松对慢性阻塞性肺疾病的疗效观察

目的探讨联合使用噻托溴铵和沙关特罗／丙酸氟替卡松对慢性阻塞性肺疾病（COPD）患者的影响。方法将50例稳定期中重度COPD患者随机分为三组：联合治疗组（Ⅰ组，噻托溴铵＋沙关特罗／丙酸氟替卡松）18例，噻托溴铵治疗组（Ⅱ组）15例，沙美特罗／丙酸氟替卡松治疗组（Ⅲ组）17例。三组均给予常规吸氧、抗感染、止咳祛痰、平喘等对症治疗，共随访观察疗程3个月。三组均于治疗前测定动脉血气、肺功能及6分钟步行距离（6MWD），治疗3个月后再次测定上述参数。结果三组治疗前后PaO2、第1秒用力呼气量（FEV1）和FEV1／用力肺活量（FVC）和6MWD均显著提高（P〈0．05），尤其Ⅰ组改善率明显高于Ⅱ组和Ⅲ组（P〈0．05）。结论联合使用噻托溴铵和沙美特罗／丙酸氟替卡松较单独使用噻托溴铵或单独使用沙美特罗／丙酸氟替卡松对COPD患者动脉血气、肺功能及运动耐量有更加明显的改善作用，本试验未发现有更多的不良反应，其安全性能够被接受，值得临床推广。

Effect of tiotropium combined with salmeterol/fluticasone for the treatment of chronic obstructive pulmonary disease

Objective To study the efficacy and safety of tiotropium and salmeterol/fluticasone on chronic obstructive pulmonary disease （COPD）. Methods Fifty patients with stable moderate -severe COPD were randomly divided into 3 groups： 18 cases in combined group （group I , tiotropium ＋ salmeterol/fluticasone） , 15 cases in tiotropium group （group Ⅱ ） , while 17 cases in salmeterol/fluticasone group （ groupⅢ）. Three groups were given conventional oxygen, antibiotics and other symptomatic treat- ment, the follow - up period was 3 months. Arterial blood gas analysis, pulmonary function and 6 - mi- nute walk distance （6MWD） were measured before and 3 months after treatment. Results PaO2, FEV1 and 6MWD were improved in all groups compared with that before treatment（ P 〈 0.05 ） , especially in combination group （ P 〈 0.05 ）. Conclusions Tiotropium combined with salmeterol/fluticasone in the treatment of moderate - severe COPD with arterial blood gas analysis, pulmonary function and exercise tol erance is more effective than only tiotropium or salmeterol/fluticasone inhalation. It is safe and worthy of being extended in clinics.