联合吸入噻托溴铵与沙美特罗／丙酸氟替卡松治疗重度COPD患者缓解期疗效的观察

【目的】观察联合吸入噻托溴铵与沙美特罗／替卡松粉吸入剂治疗重度慢性阻塞性肺疾病（COPD）缓解期的疗效。【方法】重度COPD患者68例，随机分为治疗组和对照组。在常规治疗的基础上，对照组给予吸入沙美特罗／替卡松粉（salmeterol／fluticason，SFC）吸入剂（50μg／500μg），2次／日，治疗组在此基础上联合噻托溴铵吸入刺（18μg），1次／日，坚持治疗与观察1年，每3个月进行圣乔治呼吸问卷（SGRQ）调查评分、6分钟步行距离试验（6MD），肺功能测定（FEV1、FEV1占预计值％）及详细观察并记录急性加重的住院次数及药物不良反应。【结果】两组治疗6、9、12个月后SGRQ总分减少、6MD距离增加，且较治疗前差异有显著性（P〈o．05）；治疗组9、12个月后sGRQ总分的减少、6MD距离的增加与对照组相比，差异有显著性（P〈0．05），两组治疗9、12个月后FEV1值、FEV1占预计值％均较治疗前差异有显著性（P〈0．05），但两组之间差异无显著性（P〉0．05）；治疗组急性加重住院次数为显著少于对照组（P〈0．05），两组均无明显副作用。【结论】联合噻托溴与沙美特罗／丙酸氟替卡松治疗重度COPD较单纯吸入沙美特罗／丙酸氟替卡松效果好，使用安全，值得临床推广。

Effect of Tiotropium Combined with Seretide for the Treatment of Chronic Obstructive Pulmonary Disease Patients in Remission Period

Objective]To observe the effect of tiotropium combined with seretide（salmeterol/ fluticasone propionate powder inhalant） for the treatment of severe chronic obstructive pulmonary disease（COPD） in re mission period. Methods] Sixty eight patients with severe COPD were randomly divided into treatment group and control group. The control group was given seretide（50μg/500μg） twice a day, while the treatment group was given seretide（50μg/500μg） combined with tiotropium inhalant once a day. St. George rating question- naire（SGRQ）, 6-minute walking distance test （6MD） and lung function test （FEV1 and FEV1%） were observed, and the time of hospitalization and adverse reactions were recorded. Results]Compared with before treatment, the total scores of SGRQ decreased and 6MD increased in two groups at 6-, 9- and 12-month after treatment, and there was significant difference（ P 〈0.05）. There were significant differences in the decrease of SGRQ scores and the increase of 6MD between the treatment group and control group（ P 〈0.05）. And there was significant difference in FEV1 and FEVI1% in two groups between 9- and 12 month after treatment and before treatment（ P 〈0. 05）, but there was no significant difference between two groups（ P 〉0. 05）. The time of hospitalization due to acute exacerbation in the treatment group was significantly less than that in the control group（ P 〈0.05）. No obvious complication in both groups was found. Conclusion] Tiotropium combined with seretide in the treatment of severe COPD in remission period is more effective than only seretide inhalation. It is safe and worthy of being extended in clinics.