目的 探讨硫酸特布他林联合盐酸氨溴索对老年慢性阻塞性肺疾病急性加重期(AECOPD)患者的治疗效果。方法 选取山东中医药大学附属医院收治的90例AECOPD患者,根据用药方案不同将患者分为对照组和试验组(n=45),两组均遵照诊治指南内的基础治疗方案进行治疗,其中对照组采用盐酸氨溴索注射液治疗;试验组在对照组的用药方案上加用硫酸特布他林吸入粉雾剂,两组均连续用药7 d;对比两组临床症状恢复时间,比较两组治疗前后各项肺功能指标、血清炎症因子、气道重塑指标,记录治疗期间发生的不良反应。结果 试验组治疗总有效率95.56 %显著高于对照组的80.00 %(P<0.05);试验组高热、胸闷、咳嗽、咳痰、肺部湿啰音消失时间均短于对照组(P<0.05)。治疗前,两组慢性阻塞性肺疾病评估测试量表(CAT)评分比较,差异无统计学意义(P>0.05);治疗后,两组CAT评分均较本组治疗前显著降低(P<0.05),且试验组显著低于对照组(P<0.05)。治疗前,两组各项肺功能指标比较,差异无统计学意义(P>0.05);治疗后,两组第一秒用力呼气容积占预计值(FEV1)、呼气流量峰值占预计值(PEF)、FEV1/用力肺活量(FVC)、25 %肺活量最大呼气流量(25 % MEF)均较本组治疗前显著改善(P<0.05),且试验组改善效果较对照组更明显(P<0.05)。治疗前,两组血清炎症因子水平比较,差异无统计学意义(P>0.05);治疗后,两组白细胞介素(IL)-6、IL-8、嗜酸性粒细胞(EOS)及气道重塑指标血清基质金属蛋白酶(MMP)-9、转化生长因子β1(TGF-β1)、碱性成纤维细胞生长因子(bFGF)水平均较本组治疗前显著降低(P<0.05),且试验组各项指标低于对照组(P<0.05)。两组治疗时的不良反应比较无明显差异(P>0.05)。结论 硫酸特布他林联合盐酸氨溴索治疗老年慢阻肺加重期取得较好效果,能提高患者肺功能,降低血清炎症表达,改善其气道重塑,值得临床应用。

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