京制咳嗽痰喘丸联合复方异丙托溴铵治疗慢性阻塞性肺疾病急性发作期的临床研究

目的探讨京制咳嗽痰喘丸联合复方异丙托溴铵治疗慢性阻塞性肺疾病急性发作期的临床研究。方法选取2017年1月—2018年12月中国人民解放军总医院和空军总医院收治的265例慢性阻塞性肺疾病急性发作期患者,随机分成与对照组(133例)和治疗组(132例)。对照组给予吸入用复方异丙托溴铵溶液,2.5 mL加入雾化器氧气驱动雾化吸入治疗,3次/d。治疗组在对照组基础上口服京制咳嗽痰喘丸,30粒/次,2次/d。两组均连续治疗14 d。观察两组的临床疗效,比较两组症状缓解时间、改良版英国医学研究委员会呼吸问卷(mMRC)评分、慢性阻塞性肺疾病患者自我评估测试问卷(CAT)评分、肺功能指标、血清学指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别是86.5%、95.5%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组咳嗽缓解时间、咳痰缓解时间、喘息缓解时间和肺部哮鸣音缓解时间均显著短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组m MRC评分和CAT评分均显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组mM RC评分和CAT评分均显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组第1秒用力呼气容积(FEV1)、一氧化碳弥散量(DLCO)与肺泡通气量(VA)比值(DLCO/VA)、FEV1与用力肺活量(FVC)比值(FEV1/FVC)、FEV1占预计值百分比(FEV1占预计值%)均较治疗前显著增高,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组这些肺功能指标显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组C反应蛋白(CRP)、降钙素原(PCT)、淀粉样蛋白A(SAA)、和肽素(CPP)、白三烯B4(LTB4)血清水平均较治疗前显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组这些血清学指标显著低于对照组,两组比较差异具有统计学意义(P0.05)。结论京制咳嗽痰喘丸联合复方异丙托溴铵治疗慢性阻塞性肺疾病急性发作期具有较好的临床疗效,可迅速稳定患者病情,减轻加重的呼吸道症状,保护肺功能,缓解机体炎症应激状态,具有一定的临床推广应用价值。

Clinical study on Jingzhi Kesou Tanchuan Pills combined with compound ipratropium bromide solution in treatment of acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the clinical effect of Jingzhi Kesou Tanchuan Pills Pills combined with compound ipratropium bromide in treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods Patients (265 cases) with acute exacerbation of chronic obstructive pulmonary disease in Chinese PLA General Hospital and Air Force General Hospital from January 2017 to December 2018 were randomly divided into the control group (133 cases) and treatment group (132 cases). Patients in the control group were given Compound Ipratropium Bromide Solution for inhalation, 2.5 mL added to atomization, and oxygen drived atomization, three times daily. Patients in the treatment group were po administered with Jingzhi Kesou Tanchuan Pills, 30 grains/time, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and symptom relief time, mMRC score, CAT score, pulmonary function indicators, and serological indicators in two groups were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 86.5% and 95.5%, respectively, and there were differences between two groups (P<0.05). The remission times of cough, sputum, wheezing and pulmonary asthma in the treatment group were significantly shorter than those in the control group, and there were differences between two groups (P<0.05). After treatment, mMRC score and CAT score in two groups were significantly decreased, and there were differences in the same group (P<0.05). After treatment, mMRC score and CAT score in the treatment group were lower than those in the control group, and there were differences between two groups (P<0.05). After treatment, FEV1, DLCO/VA, FEV1/FVC, and FEV1% in two groups were significantly increased, and there were differences in the same group (P<0.05). After treatment, pulmonary function indexes in the treatment group were higher than those in the control group, and there were differences between two groups (P<0.05). After treatment, CRP, PCT, SAA, CPP, and LTB₄ in two groups were significantly decreased, and there were differences in the same group (P<0.05). After treatment, the serological indicators in the treatment group were lower than those in the control group, and there were differences between two groups (P<0.05). Conclusion Jingzhi Kesou Tanchuan Pills combined with compound ipratropium bromide solution has significant effect in treatment of acute exacerbation of chronic obstructive pulmonary disease, and can rapidly stabilize the condition of patients, and also can reduce aggravated respiratory symptoms, and protect lung function, and relieve the inflammatory stress state of the body, which has a certain clinical application value.