目的 探討清開靈注射液聯(lián)合噻托溴銨治療慢性阻塞性肺病的臨床療效。方法 選取2013年2月-2015年2月在廣州市荔灣區(qū)人民醫(yī)院呼吸內(nèi)科接受治療的慢性阻塞性肺疾病患者92例,根據(jù)治療方案的差別分為對(duì)照組(46例)和治療組(46例)。所有患者均給予吸氧、抗感染、止咳化痰和平喘等基礎(chǔ)治療。對(duì)照組吸入噻托溴銨粉吸入劑,18 μg放入HandiHaler裝置中并刺破,1次/d。治療組在對(duì)照組基礎(chǔ)上靜脈滴注清開靈注射液,40 mL加入生理鹽水100 mL,1次/d。兩組患者均治療2周。觀察兩組的臨床療效,同時(shí)比較兩組動(dòng)脈血?dú)庵笜?biāo)、肺功能指標(biāo)和血清炎性因子水平變化情況。結(jié)果 治療后,對(duì)照組和治療組總有效率分別為82.61%和95.65%,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后兩組動(dòng)脈血pH值和氧分壓(pO₂)值均較同組治療前明顯增高(P<0.05),動(dòng)脈血二氧化碳分壓(pCO₂)值比同組治療前明顯降低(P<0.05);與對(duì)照組比較,治療組的動(dòng)脈血?dú)庵笜?biāo)改善更明顯(P<0.05)。治療后兩組一秒用力呼氣容積(FEV₁)、用力肺活量(FVC)和FEV₁/FVC值較同組治療前增高(P<0.05),但治療組增高更明顯(P<0.05)。治療后兩組白細(xì)胞介素-8(IL-8)、基質(zhì)金屬蛋白酶-9(MMP-9)和腫瘤壞死因子-α(TNF-α)均較同組治療前明顯降低,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組比對(duì)照組降低的更明顯,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 清開靈注射液聯(lián)合噻托溴銨治療慢性阻塞性肺病效果顯著,可明顯改善患者肺功能和降低血清炎性因子水平,具有一定的臨床推廣應(yīng)用價(jià)值。

ObjectiveTo evaluate the clinical efficacies of Qingkailing Injection combined with tiotropium bromide in treatment of chronic obstructive pulmonary disease. Methods Patients (92 cases) with chronic obstructive pulmonary disease from February 2013 to February 2015 in Liwan District People's Hospital of Guangzhou were divided into control group (46 cases) and treatment group (46 cases) based on different treatment methods. All patients were given basic treatment with oxygen inhalation, anti-infection, relieving cough, resolving phlegm, relieving asthma, etc. Patients in the control group were inhal administered with Tiotropium Bromide Powder for inhalation, 18 μg put into the HandiHaler device, then punctured, once daily; Patients in the treatment group were iv administered with Qingkailing Injection, 40 mL added into normal saline 100 mL, once daily. The patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the changes of arterial blood gas indexes, pulmonary function indexes and serum inflammatory factors levels in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment group were 82.61% and 95.65%, respectively, and there were differences between two groups (P < 0.05). After treatment, arterial blood pH value and pressure of oxygen (pO₂) in two groups were significantly increased (P < 0.05), and arterial carbon dioxide pressure (pCO₂) was significantly decreased (P < 0.05). In arterial blood gas indexes, the treatment group improved more significantly than those in the control group (P < 0.05). After treatment, forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC value of two groups were significantly increased (P < 0.05). Compared with the control group, the treatment group increased more obviously (P < 0.05). After treatment, interleukin-8 (IL-8), matrix metalloproteinase-9 (MMP-9), and tumor necrosis factor-α (TNF-α) were decreased more than those before treatment with significant difference (P < 0.05). And these indexes in treatment group were decreased more than those in the control group, and the difference was significant (P < 0.05). Conclusion Qingkailing Injection combined with thiazide supporting bromide has significant efficacy in treatment of chronic obstructive pulmonary disease, can significantly improve lung function and reduce serum inflammatory factors levels, which has a certain clinical application value.