重度COPD患者几种解痉药物的临床应用比较

目的 比较可必特气雾剂、溴化异丙托品气雾剂以及沙丁胺醇气雾剂对应用机械通气的重度慢性阻塞性肺疾病患者的支气管扩张作用。方法 对60例应用机械通气的重度慢性阻塞性肺疾病患者，随机分为三组，均实施间歇正压通气呼吸模式，并在记录气道峰压、平台压、呼气峰流速、气道阻力后，分别通过雾化器吸入沙丁胺醇气雾剂（A组）、溴化异丙托品气雾剂（B组）和可必特（C组），吸入后10、30、60、180及360min后重复记录各通气参数的变化。结果 C组在用药10min时气道峰压、气道阻力即有下降，呼气峰流速上升（t分别=2．73、2．46、2．28，P均〈0．05）。与B组比较，差异有统计学意义（F=84．26、30．59、106．73，P〈0．05），至180min时改善最为明显，至360min时气道峰压、气道阻力仍有明显下降，呼气峰流速明显上升（t分别=2．93、2．23、2．29，P均〈0．05），与A组比较，差异有统计学意义（F分别=85．76、26．77、124．12，P均〈0．05）。结论 对应用机械通气的慢性阻塞肺疾病患者，应用可必特对支气管的扩张效果强于单用溴化异丙托品气雾剂或沙丁胺醇。

Effects of several inhaled bronchodilators on patients of severe COPD

Objective To compare the effects of ipratropium bromide（IPB） , salbuta（SA） and combivent（CB） on bronchodilation in patients with severe COPD by mechanical ventilation. Methods Sixty patients, mechanically ventilated with IPPV for severe COPD, were divided into three groups. After measurement of patients＇ peak inspiratory pressure （PIP）, plateau pressure （ Pplateau ）, peak expiratory flow （PEF） and airway resistance （Raw） were noted, one group patients inhaled IPB , the other groups inhaled SA and CB respectively. PIP, Pplateau, PEF and Raw were respectively noted at the points of 10, 30, 60, 180 and 360 min after inhalation. Results In CB group, at the point of 10 minute, PIP and Raw were de- scending and PEF was ascending（ t = 2.73,2.46,2.28, P 〈 0.05） ; its effect was better than IPB group at the points of 10 and 30 min（ P 〈 0.05） and was increased at the points of 60, 180 and 360 min（ P 〈 0.05） . Its effect was better than SA group at the points of 180 and 360 min （ P 〈 0.05） . Conclusion Effects of combivent on bronehodilation in patients mechanically ventilated for COPD was greater than IPB or SA .