噻托溴铵联合阻力呼吸训练器对COPD稳定期患者的治疗效果  

Effect of tiotropium bromide combined with resistance breathing trainer on patients with COPD in stable phase

作　　者：邓莉萍 杨莹[1] 温有利 田茂良 DENG Liping;YANG Ying;WEN Youli;TIAN Maoliang(Department of Respiratory and Critical Care Medicine,First People′s Hospital of Zigong,Zigong Sichuan 643000,China)

机构地区：[1]自贡市第一人民医院呼吸与危重症医学科,四川自贡643000

出　　处：《中国急救复苏与灾害医学杂志》2022年第9期1242-1246,1260,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2018年四川省医学科研课题立项(编号:S18027)。

摘　　要：目的探究噻托溴铵联合阻力呼吸训练器在慢性阻塞性肺疾病(COPD)稳定期的临床应用价值,为临床治疗提供数据参考。方法选取自贡市第一人民医院2019年1月—2019年12月80例COPD稳定期患者作为研究对象。按照随机数字表法分对照组、观察组,各40例。两组均给予常规治疗,对照组在常规治疗基础上给予阻力呼吸训练器,观察组在对照组基础上给予噻托溴铵。比较两组治疗效果、治疗前后呼吸困难(mMRC)评分、运动耐力[6 min步行距离(6-MWT)]、气道阻力[0.1 s气道阻断压(P0.1)]、呼吸肌肌力[最大吸气压(MIP)、最大呼气压(MEP)]、炎症因子[白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]、免疫功能(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))及不良反应,并于治疗后随访6个月,比较两组急性发作次数。结果①治疗效果及预后:观察组总有效率为90.00%(36/40),高于对照组72.50%,治疗后6个月内急性发作次数少于对照组(P<0.05);②呼吸困难及运动耐力:与治疗前比较,治疗后两组mMRC评分降低,6-MWT增长,观察组均优于对照组(P<0.05);③气道阻力、呼吸肌肌力:治疗后两组P0.1低于治疗前,观察组低于对照组,MIP、MEP高于治疗前,观察组高于对照组(P<0.05);④炎症及免疫功能:与治疗前比较,治疗后两组血清IL-8、TNF-α及CD8^(+)水平降低,IL-10及CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平升高,且观察组变化幅度更为显著(P<0.05);⑤治疗安全性:两组不良反应发生率差异无统计学意义(P>0.05)。结论噻托溴铵联合阻力呼吸训练器在COPD稳定期治疗中具有良好效果,可显著改善患者气道阻力及呼吸肌肌力,同时调节机体炎症反应及免疫功能,对患者呼吸困难症状及运动耐力均有明显改善作用,进而降低治疗后急性发作风险,是安全有效的临床治疗方案,具有较高临床应用价值。Objective To explore the clinical application value of tiotropium bromide combined with resistance breathing exerciser in the stable phase of Chronic obstructive pulmonary disease(COPD).Methods 80 COPD patients in the stable period underwent conventional treatment and were randomLy divided into two equal groups:control group trained by resistance breathing exerciser for 10~15 min 3 times a day for 3 months on the basis of conventional treatment,and observation group given tiotropium bromide 18μg once every evening for 3 months in addition.The patients were followed up for 6 months after treatment.The treatment effects,number of acute attacks,dyspnea(mMRC)scores,exercise endurance[6 min walking distance(6-MWT)],airway resistance[0.1 s airway blocking pressure(P0.1)],respiratory muscle strength[maximum inspiratory pressure(MIP),and maximum expiratory pressure(MEP)],inflammatory factors[interleukin-8(IL-8),interleukin-10(IL-10),and tumor necrosis factor-α(TNF-α)],and immune function(CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+))before and after treatment,and adverse reactions were compared between the two groups.Results①Treatment effect and prognosis:The total effective rate of the observation group was 90.00%(36/40),significantly higher than that of the of the control group(72.50%,P<0.05).The number of acute attacks within 6 months after treatment of the observation group was(1.62±0.30)time,significantly less that of the control group[(2.20±0.3,P<0.001).②Dyspnea and exercise endurance:The mMRC scores of the two groups decreased and the 6-MWT increased significantly after treatment in these two groups after treatment(all P<0.05),and the respective results of the observation group were better than those of the control group(P<0.05).③Airway resistance and respiratory muscle strength:The levels of P0.1 of the two groups after treatment were both significantly lower than those before treatment(P<0.05),and the level of the P0.1 after treatment of the observation group was significantly lower than that of the con

关 键 词：慢性阻塞性肺疾病稳定期 噻托溴铵 阻力呼吸训练器 急性发作 气道阻力 呼吸肌肌力 炎症因子 免疫功能 

分 类 号：R56[医药卫生—呼吸系统]