慢性阻塞性肺疾病患者使用干粉吸入器的吸气能力  

Inhalation ability via dry powder inhalers in patients with chronic obstructive pulmonary disease

作　　者：高怡[1] 黄思琪[2] 周伟良[2] 车志[2] 佃林萍 罗嘉伟[2] 潘筱媛[2] 冼转花 郑劲平[1] 

机构地区：[1]广州医科大学附属第一医院,广州呼吸疾病研究所,呼吸疾病国家重点实验室,呼吸疾病国家临床医学研究中心,广州510120 [2]广州医科大学临床医学系,广州510182

出　　处：《广东医学》2014年第19期3002-3006,共5页Guangdong Medical Journal

基　　金：国家科技支撑计划项目(编号:2012BAI05B01;2013BAI09B09);广州医科大学大学生课外科技活动项目(编号:2012B001)

摘　　要：目的探讨不同严重程度的慢性阻塞性肺疾病(COPD)患者在不同干粉吸入器阻力状态下的吸气能力。方法将54例中老年COPD患者纳入研究,采用In-Check DIAL吸气峰流量仪,测定模拟准纳器阻力状态下的吸气峰流量(PIF-D)以及模拟都保阻力状态下的吸气峰流量(PIF-T),同时测定呼气峰流量(PEF)以及舒张后肺功能。结果 1例(1.9%)COPD患者未能达到Diskus的最低吸气流量(30 L/min)要求,12例(22.2%)未能达到Turbuhaler的最低吸气流量(60 L/min)要求,两组间比较差异有统计学意义(x2=10.581,P=0.001)。对于PIF-D,7.1%的Ⅳ级COPD患者低于理想吸气流量,Ⅱ级和Ⅲ级的PIF-D均达到理想吸气流量或以上,不同级别COPD患者的PIF-D分级分布情况无统计学差异(x2=5.665,P=0.226)。对于PIF-T,Ⅱ级、Ⅲ级、Ⅳ级的COPD患者的比例为11.8%、26.1%、28.6%,不同级别COPD患者的PIF-T分级分布情况差异无统计学意义(x2=3.222,P=0.521)。直线回归分析表明,COPD患者PEF测定值与PIF-D和PIF-T测定值均呈正相关(r=0.584,r=0.478,P=0.01)。结论通过评价COPD患者的疾病严重程度,无法判断患者是否真正有效地吸入药物。In-Check DIAL吸气峰流量仪可测定COPD患者在不同吸入器阻力状态下吸气流量,临床医生可根据患者的测定结果来为患者选用不同的吸入器,并开具合理的药物处方,适于在临床上推广应用。Objective To evaluate inhalation ability via dry powder inhaler in patients with chronic obstructive pulmonary disease （COPD）. Methods 54 COPD patients with mean age of （67. 7 ± 8.4 ） years were included. The peak inspiratory flow via Diskus （PIF -D） and Turbuhaler （PIF -T） were measured by a peak inspiratory flow meter （ In - Check DIAL ）, which could simulate the internal resistance of the Diskus and Turbuhaler . Peak expiratory flow and spirometry post - dilation were performed as well. Results 1 （ 1.9% ） patient could not achieved the required flow of 30 L/min with Diskus , while 12 （22.2%） patients could not generate the optimal flow of 60 L/min via Turbu- haler . Significant difference was found in the success rates between Diskus and Turbuhaler （P =0. 001 ）. For PIF - D, no statistical difference existed among different grades of COPD （P = 0. 226）, though 7. 1% patients in GOLD -4 did not achieve the required flow while all patients in GOLD - 2 and GOLD - 3 had obtained the optimal flow. For PIF - T, there was no statistical difference among different grades of COPD either （ P = 0. 521 ） , though 11.8%, 26. 1% and 28.6% patients in GOLD -2, GOLD -3 and GOLD -4, respectively were failed to attain the required flow. Linear re- gression analysis showed that PEF of COPI） patients was significantly positively correlated with PIF - D and PIF - T （ r = 0. 584, r = 0. 584, respectively, P = 0. 01 ）. Conclusion It is unable to determine whether patients effectively inhaled drugs according to the severity of COPD. In - Check DIAL peak inspiratory flow meter is recommended to measure the inhalation ability in conditions with different resistance of DPI. It is helpful for clinicians to choose and prescribe suitable DPI for patients with COPD.

关 键 词：吸气峰流量 慢性阻塞性肺疾病 干粉吸入器 吸入疗法 呼气峰流量 

分 类 号：R563.05[医药卫生—呼吸系统]