低剂量阿奇霉素联合噻托溴铵长期治疗对稳定期老年支气管扩张症患者肺通气功能和生活质量的影响  

Effect of Long-term Combined Treatment with Low-dose Azithromycin and Tiotropium Bromide on Pulmonary Ventilation Function and Quality of Life of the Elderly with Bronchiectasis in Stable Stage

作　　者：刘涛 陈宇清 丁凤鸣[3] 周新[3] Liu Tao;Chen Yuqing;Ding Fengming;Zhou Xin(Department of GeneralMedical Practice, Health Service Center, Changzhenzhen Community, Putuo District, Shanghai, 2000333;Department of Respiratory Medicine, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200030;Department of RespiratoryMedicine, the 1st People's HospitalAffiliated to Shanghai Jiao TongUniversity, Shanghai, 200080; P. R. China)

机构地区：[1]上海市普陀区长征镇社区卫生服务中心全科,上海200333 [2]上海交通大学附属胸科医院呼吸内科,上海200030 [3]上海交通大学附属第一人民医院呼吸内科,上海200080

出　　处：《老年医学与保健》2018年第6期622-625,629,共5页Geriatrics & Health Care

基　　金：国家自然科学基金(81300005);上海市卫生计划和生育委员会科研项目(20134367)

摘　　要：目的观察不同剂量阿奇霉素维持治疗对预防稳定期非结核性老年支气管扩张患者急性加重和对生活质量的影响以及进行安全性评价。方法选择伴有慢性化脓性呼吸道症状的成人支气管扩张症患者33例,予以口服阿奇霉素片(商品名:希舒美) 250 mg/次,1次/d,疗程为26周;吸入噻托溴铵粉雾剂(商品名:天晴速乐) 18 g/次,1次/d,疗程26周。观察治疗前后的呼吸道症状、肺功能、FACED评分及下呼吸道感染视觉模拟量表(LRTI-VAS)评分等。结果共有31例患者完成26周的随访。疗程结束时入选患者的FEV1%和FEV1/FVC较治疗前有所增高(P<0.05),FEF25-75%也有所改善[(50.63±7.60)%vs (54.52±5.39)%, P<0.05]。所有患者的CRP均降至正常水平,LRTI-VAS评分和FACED评分也显著降低[(21.70±1.76)分vs (14.74±1.34)分、(4.55±0.79)分vs (3.55±0.57)分,均P<0.05]。共有3例患者发生急性加重,其中1例患者退出研究,另2例患者在急性加重治疗期间未中断阿奇霉素治疗。共5例患者发生可能与药物相关的不良反应,包括胃部不适、心悸和头痛。结论对于稳定期老年支气管扩张症患者,阿奇霉素联合噻托溴铵维持治疗有助于改善其呼吸道症状及生活质量(FACED评分),减轻外周气道气流受限。Objective To observe the effect of maintenance treatmentwith azithomycin of different doses in preventing acute exacerbation of non-tuberculous bronchiectasis at stable stage in the elderly and the effect on quality of life and to make the evaluation of the safety.Methods33cases with chronic suppurative respiratory symptoms were selected;oral administration of azithromycin(250mg once,once a day)and inhalation of tiotropium bromide(18g once,once a day)were applied to all the cases and the courses lasted for26weeks;observationsweremade to respiratory symptoms,pulmonary function,FACED scores and the scores of lower respiratory tract infection visual analog scale(LRTI-VAS)before and after treatment.Results The forced expiratory volume in1second(FEV1),FEV1/forced ventilatory capacity(FEV1/FVC)of all the caseswere higher after treatment than those before treatment(P<0.05)and the forced expiratory flow between 25% and 75% of vital capacity(FEF25-75)was improved,from(50.63±7.60%)before treatment to(54.52±5.39%)after treatment(P<0.05);the CRP levels of all the cases dropped down to normal and the scores of LRTI-VAS and FACED were obviously lower after treatment than those before treatment[(21.70±1.76)vs(14.74±1.34),(4.55±0.79)vs(3.55±0.57)](P<0.05);3cases occurred acute exacerbation:1withdrew and2kept on taking azithromycin during acute exacerbation period;adverse effects probably related to drugs were found in5cases,including gastric discomfort,palpitation and headache.Conclusions The combined treatment with azithromycin and tiotropium bromide is effective improving the respiratory symptoms and quality of life of the ederly with bronchiectasis at stable stage and reducing airflow obstruction in peripheral airway.

关 键 词：老年支气管扩张 慢性化脓性肺病 阿奇霉素 噻托溴铵 气流受限 

分 类 号：R562.22[医药卫生—呼吸系统]