黄旺 罗培丰 薛爱丽 江丽慧 张文昌 张素平

[摘要] 目的 從小气道病变角度探讨孟鲁司特、噻托溴铵两药联用干预早期慢性阻塞性肺疾病（COPD）的效果。方法 选取2018年6月至2020年1月我院呼吸内科门诊及体检科符合早期COPD的患者120例，按随机数字表法分为研究组和对照组，每组各60例;研究组选用孟鲁司特+噻托溴铵早期干预COPD，对照组服用维生素C，观察两组小气道病变变化情况。 结果 研究组的总有效率为96.67%，明显高于对照组的18.33%，差异有统计学意义（P<0.05）;研究组治疗后的MEF75、MEF50、MEF25、RV/TLC、CAT指标均明显优于治疗前，差异有统计学意义（P<0.01）。结论 早期COPD患者选用孟鲁司特+噻托溴铵进行干预，效果显著，胸闷、咳嗽、呼吸困难等自觉症状及肺功能均获明显改善，临床应用价值较高，值得推广。

[关键词] 早期COPD;孟鲁司特;噻托溴铵;肺功能检测;小气道病变;COPD自我问卷评估测试

[中图分类号] R563.9          [文献标识码] B          [文章编号] 1673-9701（2021）36-0041-04

Exploring the clinical effects of pharmacological intervention in early COPD from the perspective of small airway lesions

HUANG Wang   LUO Peifeng   XUE Aili   JIANG Lihui   ZHANG Wenchang   ZHANG Suping

Department of Respiratory Medicine， the Second Hospital of Longyan City in Fujian Province，Longyan   364000， China

[Abstract] Objective To observe the effect of the combination of montelukast sodium and tiotropium bromide in early chronic obstructive pulmonary disease （COPD） from the perspective of small airway lesions. Methods A total of 120 patients with early COPD in outpatient clinic of the department of respiratory medicine and the department of physical examination from June 2018 to January 2020 were selected and randomly grouped into the study group（n=60） and the control group（n=60）. The study group received montelukast sodium+tiotropium bromide for early intervention of COPD， while the control group was treated with oral vitamin C. The changes of small airway lesions in both groups were observed. Results The efficacy of the study group was 96.67%， which was significantly better than 18.33% of the control group， with statistically significant differences （P<0.05）. The maximal expiratory flow in 75% vital capacity （MEF75）， maximal expiratory flow in 50% vital capacity （MEF50）， maximal expiratory flow in 25% vital capacity （MEF25）， residual volume/total lung capacity （RV/TLC）， COPD Assessment Test （CAT） score of the study group after treatment were significantly better than those before treatment， with statistically significant differences （P<0.01）. Conclusion The intervention of montelukast sodium+tiotropium bromide in early COPD patients is significantly effective in improving chest tightness， cough， dyspnea and other self-conscious symptoms and pulmonary function， and is worthy of application and promotion in clinic.

[Key words] Early COPD; Montelukast sodium; Tiotropium bromide; Pulmonary function test; Small airway lesions; COPD Assessment Test

在我国40岁以上的人群中超过13.7%的人患有慢性阻塞性肺疾病（Chronic obstructive pulmonary disease，COPD）[1]，即“慢阻肺”。主要表现为咳嗽、胸闷、气紧、呼吸困难等，使患者长期受困扰，影响其生活。而内径≤2 mm的小气道病变是引起气流阻塞的慢阻肺早期阶段，但小气道病变具有可逆性[2]。研究表明，孟鲁司特联合噻托溴铵治疗COPD临床获得显著效果[3]。故本研究对2018年6月至2020年1月中符合早期COPD的120例患者，随机选取60例给予孟鲁司特钠口服+噻托溴铵粉剂吸入治疗，另一半患者给予维生素C口服治疗，治疗1年后比较分析小气道病变改善情况，探讨研究早期COPD的干预方法，现报道如下。……