目的 探討硫酸特布他林聯(lián)合鹽酸氨溴索對老年慢性阻塞性肺疾病急性加重期(AECOPD)患者的治療效果。方法 選取山東中醫(yī)藥大學(xué)附屬醫(yī)院收治的90例AECOPD患者,根據(jù)用藥方案不同將患者分為對照組和試驗(yàn)組(n=45),兩組均遵照診治指南內(nèi)的基礎(chǔ)治療方案進(jìn)行治療,其中對照組采用鹽酸氨溴索注射液治療;試驗(yàn)組在對照組的用藥方案上加用硫酸特布他林吸入粉霧劑,兩組均連續(xù)用藥7 d;對比兩組臨床癥狀恢復(fù)時間,比較兩組治療前后各項(xiàng)肺功能指標(biāo)、血清炎癥因子、氣道重塑指標(biāo),記錄治療期間發(fā)生的不良反應(yīng)。結(jié)果 試驗(yàn)組治療總有效率95.56 %顯著高于對照組的80.00 %(P<0.05);試驗(yàn)組高熱、胸悶、咳嗽、咳痰、肺部濕啰音消失時間均短于對照組(P<0.05)。治療前,兩組慢性阻塞性肺疾病評估測試量表(CAT)評分比較,差異無統(tǒng)計學(xué)意義(P>0.05);治療后,兩組CAT評分均較本組治療前顯著降低(P<0.05),且試驗(yàn)組顯著低于對照組(P<0.05)。治療前,兩組各項(xiàng)肺功能指標(biāo)比較,差異無統(tǒng)計學(xué)意義(P>0.05);治療后,兩組第一秒用力呼氣容積占預(yù)計值(FEV1)、呼氣流量峰值占預(yù)計值(PEF)、FEV1/用力肺活量(FVC)、25 %肺活量最大呼氣流量(25 % MEF)均較本組治療前顯著改善(P<0.05),且試驗(yàn)組改善效果較對照組更明顯(P<0.05)。治療前,兩組血清炎癥因子水平比較,差異無統(tǒng)計學(xué)意義(P>0.05);治療后,兩組白細(xì)胞介素(IL)-6、IL-8、嗜酸性粒細(xì)胞(EOS)及氣道重塑指標(biāo)血清基質(zhì)金屬蛋白酶(MMP)-9、轉(zhuǎn)化生長因子β1(TGF-β1)、堿性成纖維細(xì)胞生長因子(bFGF)水平均較本組治療前顯著降低(P<0.05),且試驗(yàn)組各項(xiàng)指標(biāo)低于對照組(P<0.05)。兩組治療時的不良反應(yīng)比較無明顯差異(P>0.05)。結(jié)論 硫酸特布他林聯(lián)合鹽酸氨溴索治療老年慢阻肺加重期取得較好效果,能提高患者肺功能,降低血清炎癥表達(dá),改善其氣道重塑,值得臨床應(yīng)用。

Objective To explore the therapeutic effects of terbutaline sulfate and ambroxol hydrochloride on elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Ninety AECOPD patients admitted to the Affiliated Hospital of Shandong University of Chinese Medicine were divided into the control group and the experimental group with equal number of cases(n=45)according to ttreatment regimen, and both groups were treated according to the basic treatment plan in the diagnosis and treatment guideline, in which the control group was treated with Ambroxol Hydrochloride Injection, and the experimental group was treated with Terbutaline Sulfate Inhalation Powder Aerosol added to the treatment plan of the control group, and both groups were treated for 7 d. The recovery time of clinical symptoms was compared between the two groups, and all the lung function indexes, serum inflammatory factor, airway remodeling indexes before and after treatment were compared, and the adverse reactions occurred during the treatment were recorded. Results The total effective rate of treatment in the experimental group was 95.56 %, which was significantly higher than that of the control group (80.00 %). The time for the disappearance of high fever, chest tightness, cough, sputum, and pulmonary wet rales in the experimental group was shorter than that in the control group (P < 0.05). Before treatment, there was no statistically significant difference in chronic obstructive pulmonary disease assessment test scale (CAT) scores between the two groups (P > 0.05). After treatment, CAT scores of both groups were significantly lower than those before treatment in same group (P < 0.05), and the experimental group was significantly lower than the control group (P < 0.05). Before treatment, there was no statistically significant difference in various lung function indexes between the two groups (P > 0.05). After treatment, the first second expiratory volume of exertion accounted for the predicted value (FEV1), peak expiratory flow rate accounted for the predicted value (PEF), FEV1/exertion lung volume (FVC), and maximal expiratory flow rate at 25 % of lung volume (25 %MEF) of the two groups were all significantly improved compared with that of the group before treatment (P < 0.05) and the improvement effect was more obvious in the experimental group than in the control group (P < 0.05). Before treatment, there was no statistically significant difference in serum inflammatory factor levels between the two groups (P > 0.05). After treatment, the levels of interleukin (IL) -6, IL-8, eosinophils (EOS), and airway remodeling indexes, serum matrix metalloproteinase (MMP)-9, transforming growth factor β1 (TGF-β1), and basic fibroblast growth factor (bFGF) were significantly lower in the experimental group than in the control group (P < 0.05). Before treatment in this group were significantly lower (P < 0.05), and the indicators in the experimental group were lower than those in the control group (P < 0.05). There was no significant difference in the adverse reactions between the two groups during treatment (P > 0.05). Conclusion Terbutaline sulfate combined with ambroxol hydrochloride achieved better results in the treatment of AECOPD in the elderly, which can improve the patients' lung function, reduce the expression of serum inflammation, and improve their airway remodeling, and is worthy of clinical application.

R975