内科

【摘要】目的探讨噻托溴铵联合双水平气道正压通气治疗稳定期COPD患者的疗效以及对患者外周血超氧化物歧化酶（SOD）、过氧化脂质（LPO）水平的影响。方法选择COPD稳定期患者152例，随机分为对照组和观察组，每组76例。对照组患者进行常规治疗，观察组患者在对照组治疗的基础上使用噻托溴铵联合双水平气道正压通气治疗。治疗4周（1个疗程）后，比较两组患者的临床治疗效果、症状改善情况及生活质量，检测比较两组患者的血清SOD、LPO水平。结果1个疗程后，观察组患者的治疗总有效率为98.7%，对照组为97.4%，两组比较差异无统计学意义(P＞0.05)。观察组患者症状或体征改善时间显著短于对照组（P＜0.01）。治疗后两组患者呼吸困难指数（mMRC）、慢阻肺症状（CAT）和呼吸疾病问卷（SGRQ）评分均显著降低（P＜0.05），观察组患者mMRC、CAT和SGRQ评分显著低于对照组(P＜0.01)。治疗后两组患者外周血SOD水平显著提高、LPO水平显著降低（P＜0.05），观察组外周血SOD浓度高于对照组、LPO浓度低于对照组，差异均有统计学意义(P＜0.05)。结论噻托溴铵联合双水平气道正压通气治疗COPD稳定期患者，能够缩短患者症状或体征改善时间，有效改善患者临床症状或体征，显著提高血清SOD水平、降低 LPO水平。

【Abstract】ObjectiveTo investigate the effect of tiotropium bromide combined with bilevel positive airway pressure on stable COPD patients and its influence on serum superoxide dismutase（SOD） and lipid peroxidation（LPO） in blood. MethodsA total of 152 patients with stable chronic obstructive pulmonary disease（COPD） were randomly divided into the control group and the observation group, with 76 cases in each group. The control group was treated with conventional therapy. The observation group was treated with tiotropium bromide combined with bilevel positive airway pressure on the basis of the treatment of the control group. After 4 weeks of treatment (1 courses) later, the clinical treatment effect, symptoms improvement ,quality of life, the serum SOD and LPO levels were compared between the two groups. ResultsAfter 1 courses of treatment, the total effective rate of the observation group was 98.7%, and that of the control group was 97.4%, the difference was not statistically significant (P＞0.05). The time on improvement of symptoms or signs in the observation group was shorter than that in the control group (P＜0.01). The scores of modified medical research council（mMRC）, COPD assessment（CAT） and St.George’s respiratory questionnaire（SGRQ） were lower in the two groups after the treatment(P＜0.05). The scores of mMRC, CAT and SGRQ in the observation group were lower than those in the control group (P＜0.01). After treatment the levels of SOD in blood of two groups were increased, LPO was decreased (P＜0.05). The SOD in blood of the observation group was higher than that of the control group, and the LPO was lower than that of the control group, the difference was statistically significant (P＜0.05). ConclusionTiotropium combined with positive airway pressure in patients with stable COPD, can reduce the time on improvement of symptoms or signs , effectively improve the clinical symptoms and signs, improve the level of serum superoxide dismutase（SOD）, decrease the level of LPO.