【摘要】：目的：探討慢性阻塞性肺疾病患者規(guī)律使用噻托溴銨粉吸入劑1年后，在臨床癥狀、肺功能、急性加重風(fēng)險(xiǎn)等，在各組的變化情況。 方法：本試驗(yàn)采用病例對(duì)照研究。依照中華醫(yī)學(xué)會(huì)制定的COPD相關(guān)診斷標(biāo)準(zhǔn)診斷為慢性阻塞性肺疾病的64例患者，分為使用噻托溴銨粉吸入劑治療的噻托溴銨組和常規(guī)治療未使用噻托溴銨患者的對(duì)照組。按2011年GOLD全球策略的病情嚴(yán)重程度評(píng)估標(biāo)準(zhǔn)，分為A、B、C、D組，每組取8人入組噻托溴銨組。1年后評(píng)估兩組及各項(xiàng)對(duì)應(yīng)分組間患者，，在呼吸困難指數(shù)、肺功能、急性加重次數(shù)方面的變化情況。 結(jié)果：兩組患者及各項(xiàng)對(duì)應(yīng)分組間，入組時(shí)在性別、年齡、呼吸困難指數(shù)、肺功能及過(guò)去1年急性加重次數(shù)等均無(wú)統(tǒng)計(jì)學(xué)差異。1年后評(píng)估，發(fā)現(xiàn)噻托溴銨組患者呼吸困難指數(shù)有明顯下降(P0.05)、年急性加重次數(shù)明顯減少(P0.05)，但肺功能也有明顯下降(P0.05)；對(duì)照組患者呼吸困難指數(shù)沒(méi)有差異，年急性加重次數(shù)也沒(méi)有變化，而肺功能下降明顯（P0.001）。提示噻托溴銨粉吸入劑能改善慢阻肺的臨床癥狀和年急性加重次數(shù)。分析噻托溴銨組和對(duì)照組肺功能的差異時(shí)發(fā)現(xiàn)噻托溴銨組肺功能下降程度明顯低于對(duì)照組(P0.05)，說(shuō)明噻托溴銨粉吸入劑能延緩慢阻肺患者肺功能下降。在A、B、C、D相應(yīng)組間分析上，發(fā)現(xiàn)A組間呼吸困難指數(shù)、年急性加重次數(shù)無(wú)差別，但肺功能下降程度噻托溴銨組低于對(duì)照組(P0.05)；B組間呼吸困難指數(shù)噻托溴銨組低于對(duì)照組(P0.05)，肺功能下降程度噻托溴銨組低于對(duì)照組(P0.05)，但年急性加重次數(shù)無(wú)差別。C組間噻托溴銨組年急性加重次數(shù)明顯低于對(duì)照組(P0.05)，肺功能下降程度也低于對(duì)照組(P0.05)，但呼吸困難指數(shù)兩組間無(wú)差別。D組間噻托溴銨組呼吸困難指數(shù)低于對(duì)照組(P0.05)，年急性加重次數(shù)少于對(duì)照組(P0.05)，但肺功能下降程度兩者間沒(méi)有差異。提示噻托溴銨能延緩A組、B組、C組患者的肺功能下降速度，而對(duì)D組沒(méi)有作用。噻托溴銨能減少B組、D組的年急性加重次數(shù)，改善B組、D組的呼吸困難癥狀。 結(jié)論：噻托溴銨粉可以延緩肺功能下降的速度，改善呼吸困難指數(shù)、減少急性加重次數(shù)。 噻托溴銨能延緩A組、B組、C組患者的肺功能下降速度，減少B組、D組的年急性加重次數(shù)，改善B組、D組的呼吸困難癥狀。
[Abstract]:Objective: to investigate the changes of clinical symptoms, pulmonary function, acute exacerbation risk and so on in patients with chronic obstructive pulmonary disease (COPD) after regular use of tiotropium bromide powder inhalation for one year. Methods: a case-control study was conducted. Sixty-four patients with chronic obstructive pulmonary disease (COPD) were divided into two groups: tiotropium group treated with tiotropium powder inhalation and control group with routine treatment without tiotropium bromide according to the COPD diagnostic criteria established by the Chinese Medical Association. According to the criteria for evaluating the severity of GOLD's global strategy in 2011, the patients were divided into two groups: group A (n = 8) and group D (n = 8). One year later, patients in two groups and their corresponding groups were evaluated for dyspnea index and pulmonary function. Changes in the number of acute exacerbations. Results: there were no significant differences in sex, age, dyspnea index, pulmonary function and acute exacerbation in the past year between the two groups. It was found that the dyspnea index of patients in tiotropium group was significantly decreased (P0.05), the number of acute exacerbations was significantly decreased (P0.05), but the pulmonary function was also significantly decreased (P0.05). There was no difference in dyspnea index and the number of acute exacerbations in the control group, but the pulmonary function decreased significantly (P0.001). The results suggest that tiotropium bromide powder inhalation can improve the clinical symptoms and acute exacerbation times of COPD. After analyzing the difference of pulmonary function between tiotropium group and control group, it was found that the decrease of pulmonary function in tiotropium group was significantly lower than that in control group (P0.05), which indicated that tiotropium powder inhalation could delay the decline of pulmonary function in patients with chronic obstructive pulmonary disease. There was no significant difference in dyspnea index and acute exacerbation between group A and group A, but the degree of pulmonary function decline was lower in tiotropium group than that in control group (P0.05). The index of dyspnea in group B was lower than that in control group (P0.05), and the degree of pulmonary function decline in group B was lower than that in group B (P0.05). The number of acute exacerbations in group C was significantly lower than that in control group (P0.05), and the degree of pulmonary function decline was also lower than that in control group (P0.05). But there was no difference in dyspnea index between two groups. The dyspnea index of group D was lower than that of control group (P0.05), the number of acute exacerbation was less than that of control group (P0.05), but there was no difference between the two groups in the degree of pulmonary function decline. It suggested that tiotropium bromide could delay the decline of pulmonary function in group A, group B and group C, but had no effect on group D. Tiotropium bromide decreased the number of acute exacerbations in group B and D, and improved dyspnea in group B and D. Conclusion: tiotropium bromide powder can delay the decline of pulmonary function, improve the index of dyspnea and decrease the times of acute exacerbation. Tiotropium bromide could delay the decline of pulmonary function in group A, group B and group C, decrease the number of acute exacerbations in group B and group D, and improve the symptoms of dyspnea in group B and group D.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.9

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