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目的探讨噻托溴铵与大剂量舒利迭联用治疗重度支气管哮喘合并慢性阻塞性肺病(COPD)的临床价值。方法选取2014年12月至2016年6月重庆市渝北区人民医院接受治疗的重度支气管哮喘合并COPD患者50例选为观察对象,随机分为观察组和对照组,每组25例。其中对照组患者接受复方异丙溴胺气雾剂与氟替卡松(中等剂量)进行治疗,观察组在对照组治疗基础上加用噻托溴铵与大剂量舒利迭治疗,两组患者均接受1年的用药治疗,若出现急性发作则进行1次/月复诊,对两组患者治疗前后哮喘控制情况[肺功能及哮喘控制测试(ACT)]、肺功能变化情况[1秒用力呼气量(FEV1)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)、1 s用力呼气量占预计值百分比(FEV1%预计值)]、急性加重发作次数与间隔时间以及不良反应发生情况进行比较。结果两组患者治疗前ACT评分对比,差异无统计学意义(P>0.05),治疗后,两组患者的ACT评分均明显较治疗前提升;治疗后,观察组患者的FEV1为(2.91±0.19)L,FEV1/FVC为(70.39±5.14)%,FEV1%预计值为(65.87±6.96)%,与治疗前比较明显升高,且幅度大于对照组(P<0.05);观察组患者治疗后的急性加重发作次数为(3.52±0.79)次,少于对照组,其急性加重发作间隔时间为(69.98±4.35)d,明显长于对照组(P<0.05)。两组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论噻托溴铵与大剂量舒利迭联用治疗重度支气管哮喘合并COPD,有利于改善患者的哮喘症状及肺功能,其临床应用效果可观。
Objective To investigate the clinical value of tiotropium in combination with high-dose seretide in the treatment of severe bronchial asthma with chronic obstructive pulmonary disease (COPD). Methods Fifty patients with severe bronchial asthma and COPD who were treated in Yubei District People’s Hospital from December 2014 to June 2016 were selected as observation subjects and randomly divided into observation group and control group with 25 cases in each group. Patients in the control group were treated with isoflavanide aerosol and fluticasone (medium dose) for treatment. The observation group was treated with tiotropium and high dose seretide on the basis of the control group, and both groups received 1 Years of drug treatment, if there is an acute attack was carried out 1 / month referral, the two groups of patients before and after treatment of asthma control [lung function and asthma control test (ACT)], changes in lung function [1 second forced expiratory volume FEV1), forced expiratory volume in 1 second / forced vital capacity (FEV1 / FVC), forced expiratory volume in 1 s as a percentage of expected value (FEV1% predicted)], the number of exacerbations and interval time, and the incidence of adverse reactions Compare Results There was no significant difference in ACT score between the two groups before treatment (P> 0.05). After the treatment, the ACT scores of both groups were significantly improved compared with those before treatment. After treatment, FEV1 in the observation group was (2.91 ± 0.19 ), The FEV1 / FVC was (70.39 ± 5.14)% and FEV1% was (65.87 ± 6.96)%, which was significantly higher than that before treatment (P <0.05) (3.52 ± 0.79) times, less than the control group. The interval time of acute exacerbation was 69.98 ± 4.35 days, which was significantly longer than that of the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusions Tiotropium bromide and high dose of seretide combined with severe bronchial asthma combined with COPD, help to improve the patient’s asthma symptoms and lung function, its clinical application of considerable effect.