噻托溴铵联合肺康复治疗轻中度支气管扩张症的疗效_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

蔡仁萍 , 潘倩倩 , 孙培欣 , 时海洋 ,  吕红霞

山东第一医科大学附属莱钢医院呼吸科（山东济南 250000）;

Corresponding author：

吕红霞, Email: lhx761006@sina.com

Keywords：

噻托溴铵; 支气管扩张症; 支气管扩张严重程度指数; 肺康复

DOI：

10.7507/1671-6205.201904009

Video：

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目的探讨噻托溴铵联合肺康复治疗轻中度稳定期支气管扩张症的有效性。方法纳入 2017 年 9 月至 12 月就诊于山东第一医科大学附属莱钢医院呼吸科支气管扩张严重程度指数（BSI）评分为轻中度的稳定期支气管扩张症患者 90 例，随机分为常规治疗组、噻托溴铵组和联合治疗组，各 30 例。规律治疗 1 年后，比较三组患者改良呼吸困难指数（mMRC）评分、BSI 评分和肺通气功能检查的变化。结果治疗后常规治疗组 mMRC 为（2.00±1.08）分，BSI 评分为（4.40±0.89）分，明显高于联合治疗组［（1.37±0.49）分、（2.37±1.13）分］和噻托溴铵组［（1.47±0.57）分、（3.40±1.16）分］，差异均有统计学意义（均 P<0.05）。常规治疗组第 1 秒用力呼气容积占预计值百分比（FEV₁%pred）为（71.70±6.46）%，用力肺活量占预计值百分比（FVC%pred）为（63.80±6.67）%，FEV₁/FVC 为（74.00±5.47）%，明显低于噻托溴铵组［（74.97±5.33）%、（70.83±8.41）%、（79.47±4.90）%］和联合治疗组［（78.53±4.75）%、（74.23±5.19）%、（81.70±5.80）%］，差异均有统计学意义（均 P<0.05）。联合治疗组 FEV₁%pred 明显高于噻托溴铵组，而 BSI 评分明显低于噻托溴铵组，差异有统计学意义（P<0.05）。结论噻托溴铵粉吸入剂联合肺康复治疗能减轻支气管扩张症患者的呼吸困难，提高肺通气功能，改善预后。

Citation： 蔡仁萍, 潘倩倩, 孙培欣, 时海洋, 吕红霞. 噻托溴铵联合肺康复治疗轻中度支气管扩张症的疗效. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(4): 403-406. doi: 10.7507/1671-6205.201904009 Copy

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2.	梅静静, 王焕勤, 刘媛华, 等. LABA/LAMA和LABA/ICS治疗COPD稳定期的安全性及有效性荟萃分析. 国际呼吸杂志, 2018, 38(14): 1041-1048.
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5.	张静, 尚茜, 马利军, 等. 肺康复治疗中重度稳定期慢性阻塞性肺疾病患者的疗效观察. 中国呼吸与危重监护杂志, 2019, 18(4): 314-317.
6.	Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med, 2014, 189(5): 576-585.
7.	成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识. 中华结核和呼吸杂志, 2012, 35(7): 485-492.
8.	Pothirat C, Chaiwong W, Phetsuk N. Efficacy of a simple and inexpensive exercise training program for advanced chronic obstructive pulmonary disease patients in community hospitals. J Thorac Dis, 2015, 7(4): 637-643.
9.	刘振刚. 吸入沙美特罗替卡松治疗支气管扩张合并气流受限患者的前瞻性\随机对照研究[D]. 山东: 山东大学医学院, 2012.
10.	Martinez-Garcia MA, Soler-Cataluna JJ, Catalan-Serra P, et al. Clinical efficacy and safety of budesonide-formoterol in non-cystic fibrosis bronchiectasis. Chest, 2012, 141(2): 461-468.
11.	Wei P, Yang JW, Lu HW, et al. Combined inhaled corticosteroid and long-acting β2-adrenergic agonist therapy for noncystic fibrosis bronchiectasis with airflow limitation: an observational study. Medicine, 2016, 95(42): e5116.
12.	徐海玲. 噻托溴铵治疗中重度稳定期慢性阻塞性肺疾病的疗效与安全性分析. 国际医药卫生导报, 2016, 22(17): 2672-2675.
13.	Beeh KM, Derom E, Echave-Sustaeta J, et al. The lung function profile of once-daily tiotropium and olodaterol via Respimat^® is superior to that of twice-daily salmeterol and fluticasone propionate via Accuhaler^® (ENERGITO^® study). Int J Chronic Obstruct Pulm Dis, 2016, 11: 193-205.
14.	苏晓波, 王立茵, 吴斌, 等. 噻托溴铵粉吸入剂对支气管扩张稳定期患者的临床效果及安全性研究. 当代医学, 2016, 22(30): 134-134.
15.	廖晓斌, 戴志辉, 杨勇琼. 噻托溴铵在支气管扩张伴阻塞性通气障碍患者中应用价值探讨. 临床肺科杂志, 2015, 20(4): 743-744, 748.
16.	Jaong HJ, Lee H, Carriere KC, et al. Effects of long-term bronchodilators in bronchiectasis patients with airflow limitation based on bronchodilator response at baseline. Int J Chron Obstruct Pulmon Dis, 2016, 11: 2757-2764.
17.	Gloeckl R, Schneeberger T, Jarosch I, et al. Pulmonary rehabilitation and exercise training in chronic obstructive pulmonary disease. Dtsch Arztebl Int, 2018, 115(8): 117-123.
18.	周敏, 赵建平. 现代肺康复常用方法. 中国实用内科杂志, 2018, 38(5): 410-413.

1. 周玉民, 王辰, 姚婉贞, 等. 我国7省市40岁及以上居民支气管扩张症的患病情况及危险因素调查. 中华内科杂志, 2013, 52(5): 379-382.
2. 梅静静, 王焕勤, 刘媛华, 等. LABA/LAMA和LABA/ICS治疗COPD稳定期的安全性及有效性荟萃分析. 国际呼吸杂志, 2018, 38(14): 1041-1048.
3. Spruit MA, Singh SJ, Garvey C, et al. ATS/ERS Task Force on Pulmonary Rehabilitation. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-64.
4. Corhay JL, Dang DN, Van CH, et al. Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy. Int J Chron Obstruct Pulmon Dis, 2014, 9: 27-39.
5. 张静, 尚茜, 马利军, 等. 肺康复治疗中重度稳定期慢性阻塞性肺疾病患者的疗效观察. 中国呼吸与危重监护杂志, 2019, 18(4): 314-317.
6. Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med, 2014, 189(5): 576-585.
7. 成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识. 中华结核和呼吸杂志, 2012, 35(7): 485-492.
8. Pothirat C, Chaiwong W, Phetsuk N. Efficacy of a simple and inexpensive exercise training program for advanced chronic obstructive pulmonary disease patients in community hospitals. J Thorac Dis, 2015, 7(4): 637-643.
9. 刘振刚. 吸入沙美特罗替卡松治疗支气管扩张合并气流受限患者的前瞻性\随机对照研究[D]. 山东: 山东大学医学院, 2012.
10. Martinez-Garcia MA, Soler-Cataluna JJ, Catalan-Serra P, et al. Clinical efficacy and safety of budesonide-formoterol in non-cystic fibrosis bronchiectasis. Chest, 2012, 141(2): 461-468.
11. Wei P, Yang JW, Lu HW, et al. Combined inhaled corticosteroid and long-acting β2-adrenergic agonist therapy for noncystic fibrosis bronchiectasis with airflow limitation: an observational study. Medicine, 2016, 95(42): e5116.
12. 徐海玲. 噻托溴铵治疗中重度稳定期慢性阻塞性肺疾病的疗效与安全性分析. 国际医药卫生导报, 2016, 22(17): 2672-2675.
13. Beeh KM, Derom E, Echave-Sustaeta J, et al. The lung function profile of once-daily tiotropium and olodaterol via Respimat^® is superior to that of twice-daily salmeterol and fluticasone propionate via Accuhaler^® (ENERGITO^® study). Int J Chronic Obstruct Pulm Dis, 2016, 11: 193-205.
14. 苏晓波, 王立茵, 吴斌, 等. 噻托溴铵粉吸入剂对支气管扩张稳定期患者的临床效果及安全性研究. 当代医学, 2016, 22(30): 134-134.
15. 廖晓斌, 戴志辉, 杨勇琼. 噻托溴铵在支气管扩张伴阻塞性通气障碍患者中应用价值探讨. 临床肺科杂志, 2015, 20(4): 743-744, 748.
16. Jaong HJ, Lee H, Carriere KC, et al. Effects of long-term bronchodilators in bronchiectasis patients with airflow limitation based on bronchodilator response at baseline. Int J Chron Obstruct Pulmon Dis, 2016, 11: 2757-2764.
17. Gloeckl R, Schneeberger T, Jarosch I, et al. Pulmonary rehabilitation and exercise training in chronic obstructive pulmonary disease. Dtsch Arztebl Int, 2018, 115(8): 117-123.
18. 周敏, 赵建平. 现代肺康复常用方法. 中国实用内科杂志, 2018, 38(5): 410-413.

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