目的 探討羧甲司坦聯(lián)合沙美特羅替卡松氣霧劑治療穩(wěn)定期D組慢性阻塞性肺疾病(COPD)患者的臨床療效.方法 選取2011年8月—2013年6月就診于天津市第四中心醫(yī)院處于穩(wěn)定期D組COPD患者96例,隨機分為治療組(50例)和對照組(46例).對照組在常規(guī)治療基礎(chǔ)上吸入沙美特羅替卡松氣霧劑,1撳/次,2次/d.治療組在對照組治療的基礎(chǔ)上口服羧甲司坦口服溶液10 mL/次,3次/d.兩組均連續(xù)治療48周.觀察兩組患者治療前,治療8、24、48周運動耐量、呼吸困難指數(shù)(mMRC)及肺功能的變化,同時觀察兩組患者治療過程中急性加重次數(shù).結(jié)果 兩組患者6 min步行距離(6MWD)在治療8、24、48周后均較治療前顯著增加,mMRC均較治療前有所降低,治療前后差異有統(tǒng)計學(xué)意義(P<0.05);治療24、48周治療組6MWD顯著長于對照組,mMRC顯著低于對照組,兩組比較差異有統(tǒng)計學(xué)意義(P<0.05).兩組患者在治療24、48周第1秒用力呼氣容積(FEV1)、FEV1占預(yù)計值百分比(FEV1/pred%)均較治療前有所增加,治療前后差異有統(tǒng)計學(xué)意義(P<0.05);治療24、48周治療組患者FEV1、FEV1/pred%顯著高于對照組,兩組比較差異有統(tǒng)計學(xué)意義(P<0.05).結(jié)論 羧甲司坦聯(lián)合沙美特羅替卡松氣霧劑治療穩(wěn)定期D組COPD患者具有較好的臨床療效,可增加患者的運動耐力,改善呼吸困難癥狀和肺功能,值得臨床推廣應(yīng)用.

Objective To investigate the clinical effect of carbocisteine combined with Salmeterol Xinafoate and Fluticasone Propionate Aerosol in treatment of stable chronic obstructive pulmonary disease (COPD) of group D. Methods The patients with stable COPD of group D (96 cases) of Tianjin Fourth Center Hospital from August 2011 to June 2013 were randomly divided into treatment (n = 50) and control (n = 46) groups. The patients in the treatment group were administered with Salmeterol Xinafoate and Fluticasone Propionate Aerosol on the basis of conventional treatment, 1 press/time, twice daily. The patients in the treatment group were po administered with Carbocisteine Oral Solution at the basis of the control group, 10 mL/time, three times daily. The patients in two groups were treated for 48 weeks. The changes of exercise tolerance, dyspnea index (mMRC), and pulmonary function in two groups before treatment, and treated for 8, 24, and 48 weeks were observed. At the same time, the number of exacerbation were observed in the process of treatment. Results 6MWDS in two groups was significant increased, the mMRC was reduced in 8, 24, and 48 weeks of treatment, and the difference was statistically significant in the same group before and after treatment (P < 0.05). 6MWDS of the treatment group was longer and mMRC was significantly lower than that in the control group in 24 and 48 weeks of treatment, and there were differences between the two groups (P < 0.05). FEV1 and FEV1/pred% in two groups were increased in 24 and 48 weeks of treatment, and the difference was statistically significant in the same group before and after treatment (P < 0.05). FEV1 and FEV1/pred% in treatment group were higher than those in the control group in 24 and 48 weeks of treatment, and there were differences between the two groups (P < 0.05). Conclusion Carbocisteine combined with Salmeterol Xinafoate and Fluticasone Propionate Aerosol has the good clinical effect in treatment of stable COPD of group D, and can increase exercise endurance, while can improve the symptoms of dyspnea and lung function, which is worth clinical promotion.