噻托溴铵联合运动训练治疗慢性阻塞性肺疾病

目的：观察吸入噻托溴铵联合运动训练对慢性阻塞性肺疾病（COPD）稳定期患者的临床疗效。方法将72例COPD稳定期患者随机分为两组，治疗组和对照组各36例。治疗组给予长效M-受体阻滞剂噻托溴铵粉吸入剂18μg，每日一次，同时联合进行运动训练，包括：呼吸训练、上肢肌力训练及全身有氧耐力训练。对照组仅运动训练治疗。观察两组治疗期间急性发作情况、生活质量评估和肺功能改善情况。结果6个月后，治疗组患者治疗后COPD急性发作次数、天数及呼吸困难量表（mMRC）评分均较治疗前明显减少，肺活量（FVC）、第1秒用力呼出量（FEV1）、FEV1占预计值百分比均较治疗前增加，差异均有统计学意义（t分别=4.55、3.56、3.12、2.86、2.90、1.51、3.31，P均＜0.05）；对照组患者治疗前后无明显变化，差异均无统计学意义（t分别=0.93、0.18、0.19、0.13、0.11、0.20、0.18，P均＞0.05）。治疗组患者各指标治疗前后差值均较对照组差值比较，差异均有统计学意义（t分别=5.62、4.66、3.67、2.65、2.70、4.03、2.89， P均＜0.05）。结论吸入噻托溴铵联合运动训练治疗COPD稳定期患者疗效确切，可明显改善患者的肺功能和运动耐力，减少急性发作，提高患者的生存质量。

Effect of tiotropium combined exercise training on patients with chronic obstructive pulmonary disease

Objective To estimate the clinical curative of inhalating Tiotropium combined exercise training on patients with chronic obstructive pulmonary disease （COPD）. Methods A total of 72 COPD patients were randomly divided into treatment group（n=36） and control group（n=36）. The treatment group was given Tiotropium 18μg everyday once and ex-ercise training, including breath training, upper limb strength training and whole body aerobic endurance training. The control group was only given exercise training. Acute accidents, quality of life and lung function were evaluated. Results After 6 months, compared with prior treatment, acute accidents occurring and days, mMRC scores of treatment group were significantly reduced and forced vital capacity（FVC）, forced expiratory volume in one second（FEV1） and FEVl%were sig-nificantly increased （t=4.55,3.56,3.12,2.86,2.90,1.51,3.31, P〈0.05）. There were no statistical difference between prior and post treatment of control group （t=0.93,0.18,0.19,0.13,0.11,0.20,0.18,P〉0.05）. Compared with difference value of control group, every index of treatment group were significantly large （t=5.62,4.66,3.67,2.65,2.70,4.03,2.89,P〈0.05）. Conclusion Tiotropium combined exercise training could obviously improve lung function and exercise tolerance of COPD patients, so as to improve life quality and reduce acute episodes.