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目的观察噻托溴胺对稳定期慢性阻塞性肺疾病(COPD)患者深吸气量的影响,探讨深吸气量(IC)对评价支气管扩张剂疗效评估的价值。方法将2003年8月至2005年3月南京医科大学附属南京第一医院呼吸内科收治的60例稳定期COPD患者,随机分成观察组(A组)噻托溴胺粉雾剂吸入;对照组(B组)安慰剂吸入。于研究第1天、第43天(约6周)、第85天(约12周)检测1秒钟用力呼气量(FEV1)、FEV1占预计值的百分比[FEV1(%)]、用力呼气量(FVC)、FEV1/FVC、IC等指标。结果观察组FEV1在第6周与对照组比较显著升高(t=2.018,P=0.048),12周差异无显著性(t=1.723,P=0.090);FEV1(%)在第6周、12周与对照组比较差异无显著性(t分别为1.761、1.387,P分别为0.083、0.171);FVC在第6周、12周与对照组比较,均有显著升高(t分别为2.762、2.255,P分别为0.008、0.029);FEV1/FVC在第6周、12周与对照组比较,差异无显著性(t分别为0.370、0.668,P分别为0.713、0.507);IC在第6周、12周较对照组显著增高(t分别为3.204、3.109,P分别为0.002、0.003)。结论噻托溴胺可使稳定期COPD患者IC增大。对于判断COPD气流受限的指标FEV1/FVC、FEV1(%),用于判断支气管扩张剂的疗效方面则不够敏感。IC是评价支气管扩张剂疗效的可靠指标。
Objective To observe the effect of tiotropium on deep inspiratory volume in patients with chronic obstructive pulmonary disease (COPD) in stable phase and to evaluate the value of deep inspiratory volume (IC) in assessing the efficacy of bronchodilator. Methods Sixty patients with stable COPD admitted to Department of Respiratory Medicine, Nanjing First Hospital Affiliated to Nanjing Medical University from August 2003 to March 2005 were randomly divided into observation group (group A) and tiotropium powder aerosol inhalation. The control group Group B) placebo inhalation. The forced expiratory volume at 1 second (FEV1), the percentage of predicted FEV1 [FEV1 (%)] on the first day, the 43th day (about 6 weeks) and the 85th day Gas volume (FVC), FEV1 / FVC, IC and other indicators. Results The FEV1 in the observation group was significantly higher than that in the control group at the 6th week (t = 2.018, P = 0.048). There was no significant difference at 12 weeks (t = 1.723, P = 0.090) (T = 1.761,1.387, P = 0.083,0.171, respectively); FVC increased significantly at week 6 and 12 compared with control group (t = 2.762, 2.255, P = 0.008,0.029, respectively). There was no significant difference in FEV1 / FVC between the 6th week and the 12th week in the control group (t = 0.370,0.668, P = 0.713,0.507, respectively) , 12 weeks significantly higher than the control group (t were 3.204,3.109, P respectively 0.002,0.003). Conclusion Tiotropium can increase the IC of patients with stable COPD. FEV1 / FVC, FEV1 (%), which are indicators of COPD airflow limitation, are not sensitive enough to determine the efficacy of bronchodilators. IC is a reliable indicator of the efficacy of bronchodilators.