噻托溴铵粉吸入剂治疗支气管扩张症的疗效观察

Clinical Observation of Spiriva in Treatment of Bronchiectasis

关键词:  支气管扩张症  噻托溴铵  用力呼气量  深吸气量  支气管扩张剂

Key words:  bronchiectasis  tiotropium bromide  FVC  IC  bronchodilators

摘要:

目的 探讨噻托溴铵粉吸入剂(思力华)对支气管扩张症的治疗作用，并探讨深吸气量(IC)、用力呼气量(FVC)对评价支气管扩张剂的疗效评估的价值。方法 30例支气管扩张症患者随机分为治疗组16例，对照组14例。对照组给予支气管扩张症常规治疗，治疗组在常规治疗基础上给予噻托溴铵18 μg吸入，qd，疗程6个月。治疗前评估2组一般情况，测定基线肺功能、临床症状评分，治疗后比较两组肺功能IC、FVC、第1秒用力呼气量占预计值的百分比(FEV1%pred)，第1秒用力呼气量占用力呼气量(FVC)的百分比FEV1∕FVC、临床症状评分，疗效评定，急性加重次数，不良反应的差异。结果 治疗后2组肺功能IC、FVC、FEV₁%pred、FEV₁∕FVC(%)均较治疗前增高，有显著性差异(P<0.05)，临床症状评分明显高于治疗前、急性发作次数明显低于治疗前(P<0.05)。其中治疗组在临床症状评分改善、急性加重次数减少、治疗疗效、以及肺功能IC、FVC上优于对照组，二者存在显著性差异(P<0.05)。两组均无明显不良反应发生情况。结论 联合使用噻托溴铵治疗支气管扩张症能改善患者的肺通气功能，减轻咳嗽、咳痰、气促、喘息症状，减少急性发作次数，减轻未来发作风险。噻托溴铵可提高支气管扩张症患者的IC、FVC。也提示IC、FVC可以评估支气管扩张剂的疗效，且较FEV₁∕FVC、FEV₁%pred更敏感。

Abstract:

OBJECTIVE To investigate the effect of tiotropium bromide inhalation powder (Spiriva) in treating bronchiectasis. To observe the influence of tiotropium bromide on inspiratory capacity(IC) and forced expiratory volume(FVC) in patients with brochiectasis and to investigate the value of IC, FVC in evaluating therapeutic effect of brochodilators. METHODS Thirty bronchiectasis patients were randomly divided into 2 groups: control group(n=14) and observation group(n=16), each group received conventional therapy. Besides of this, patients in treatment group were treated with tiotropium bromide 18 μg QD inhalation, the course of treatment was 6 months. Before treatment, general condition, the clinical symptoms, pulmonary function of two groups were evaluated. After treatment, pulmonary function, IC, FVC, FEV₁%pred, FEV₁/FVC, clinical symptom score, curative effect evaluation, the times of acute exacerbation, differences in adverse reaction were compared between two groups. RESULTS Pulmonary function, IC, FVC, FEV₁%pred were increased in both groups after treatment, there was significant difference(P<0.05), clinical symptom score was significantly higher than before treatment, the number of acute attack was significantly lower than that before treatment (P<0.05). The clinical symptom score, acute exacerbation frequency and pulmonary function of IC, FVC in treatment group were improved than the control group, there were significant differences between the two groups(P<0.05). No obvious adverse reactions were observed in two groups. CONCLUSION The combined use of tiotropium bromide in treatment of bronchiectasis can improve the pulmonary ventilation function of patients, relieve symptoms including cough, expectoration, shortness of breath, wheezing, and reduce the frequency of acute attack. Tiotropium bromide can increase IC, FVC of bronchiectasis patients. IC and FVC can assess the efficacy of bronchodilators as reliability index. They are more sensitive than FEV₁∕FVC, FEV1%pred.