目的 探究噻托溴铵联合沙美特罗氟替卡松对肺癌合并慢性阻塞性肺疾病(COPD)稳定期患者术后肺功能、血气指标及炎症反应的影响.方法 入选肺癌合并COPD稳定期术后患者为研究对象,依据治疗方法不同按照队列法分为对照组和试验组.对照组术前3 d给予患者噻托溴铵粉雾剂18 μg吸入治疗,bid,试验组在对照组基础上同时给予沙美特罗替卡松吸入粉雾剂治疗,每次1吸,bid,2组持续治疗3个月.比较2组治疗前后肺功能[用力肺活量(FVC)、第一秒用力呼气量(FEV1)、呼气高峰流量(PEF),FEV1/FVC]、改良版英国医学研究委员会呼吸问卷(mMRC)评分、慢性阻塞性肺病评估测试(CAT)评分、癌症患者生命质量量表(QLQ-C30)评分、血气指标[动脉血氧分压(PaO2)、动脉血血氧饱和度(SaO2)、动脉血二氧化碳分压(PaCO2)]和炎症反应指标[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]及药物不良反应发生情况.结果 试验组和对照组分别纳入47和45例.治疗后,试验组和对照组的总有效率分别为91.49％(43例/47例)和75.56％(34例/45例),在统计学上差异有统计学意义(P＜0.05).治疗后,试验组和对照组FEV1/FVC分别为(0.62±0.10)％和(0.48±0.05)％,PEF 分别为(1.94±0.20)和(1.02±0.11)L·s-1,mMRC 评分分别为(2.01±0.25)和(2.26±0.23)分,CAT评分分别为(16.03±1.74)和(20.03±2.17)分,QLQ-C30量表体能功能得分分别为(79.31±8.92)和(75.04±7.86)分,PaO2分别为(70.34±6.98)和(62.02±6.31)mmHg,IL-6表达水平分别为(16.43±1.65)和(21.55±2.27)pg·mL-1,试验组上述指标与对照组比较,在统计学上差异均有统计学意义(均P＜0.05).试验组和对照组药物不良反应主要有皮肤过敏、恶心呕吐,试验组和对照组药物不良反应总发生率分别为34.04％和23.40％,在统计学上差异无统计学意义(P＞0.05).结论 噻托溴铵联合沙美特罗氟替卡松治疗肺癌合并COPD稳定期患者术后临床效果确切,可有效改善患者肺功能、预后和动脉血气等.
Objective To investigate the effects of tiotropium bromide combined with salmeterol fluticasone on postoperative lung function,blood gas index,and inflammatory response in patients with lung cancer complicated with stable chronic obstructive pulmonary disease(COPD).Methods Patients with lung cancer complicated with stable COPD after surgery were selected as research subjects and divided into control group and treatment group according to different treatment methods.The control group received 18 μg of tiotropium bromide powder for inhalation therapy,bid,for 3 days before surgery,while the treatment group received additional salmeterol inhalation powder treatment on basis of the control group's treatment,1 inhalation each time,bid,for 3 months.Lung function[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),FEV1/FVC],modified British Medical Research Council(mMRC)dyspnea scale,chronic obstructive pulmonary disease assessment test(CAT)score,quality of life questionnaire-C30(QLQ-C30)score,blood gas index[arterial oxygen pressure(PaO2),arterial blood oxygen saturation(SaO2),arterial carbon dioxide pressure(PaCO2)],inflammatory response indicators[interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)],and occurrence of adverse drug reactions in the two groups with compared before and after treatment.Results Forty-seven and forty-five cases were included in the treatment and control groups,respectively.After treatment,the total effective rates of the treatment and control groups were 91.49％(43 cases/47 cases)and 75.56％(34 cases/45 cases)respectively,and the differences were statistically significant(P＜0.05).After treatment,the FEV1/FVC of the treatment and control groups were(0.62±0.10)％and(0.48±0.05)％;PEF were(1.94±0.20)and(1.02±0.11)L·s-1;mMRC scores were 2.01±0.25 and 2.26±0.23;CAT scores were 16.03±1.74 and 20.03±2.17;QLQ-C30 physical functioning scores were 79.31±8.92 and 75.04±7.86;PaO2 were(70.34±6.98)and(62.02±6.31)mmHg;IL-6 expression levels were(16.43±1.65)and(21.55±2.27)pg·mL-1.The above indexes in the treatment group compared with the control group were all statistically significant(all P＜0.05).The main adverse drug reactions in the treatment and control groups were skin allergies and nausea/vomiting,and the total incidence of adverse drug reactions in the treatment and control groups were 34.04％and 23.40％,with no statistically significant difference(P＞0.05).Conclusion Tiotropium bromide combined with salmeterol fluticasone is effective for patients with lung cancer complicated with stable COPD after surgery,which significantly improves their lung function,prognosis,and arterial blood gas levels.
宣自磊;丁瑞阳;杨文柱
皖西卫生职业学院附属医院、六安市第二人民医院呼吸内科,安徽六安 237000
药学
噻托溴铵;沙美特罗氟替卡松;肺癌;术后;慢性阻塞性肺疾病;肺功能;预后
tiotropium bromide;salmeterol fluticasone;lung cancer;postoperation;chronic obstructive pulmonary disease;pulmonary function;prognosis
《中国临床药理学杂志》 2024 (008)
1096-1100 / 5
10.13699/j.cnki.1001-6821.2024.08.002
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