简玲丽 杨烨 杨旭 陈双萍

【摘要】 目的：探讨振动排痰仪联合异丙托溴铵、沙丁胺醇雾化吸入在矽肺合并慢性阻塞性肺疾病（COPD）治疗中的应用。方法：选取2021年6月—2023年6月在萍乡矿业集团有限责任公司总医院就诊的76例矽肺合并COPD患者进行研究。按照入院顺序使用电脑数字随机分组法将患者分为观察组与对照组，各38例。所有患者均接受常规抗感染、平喘解痉对症治疗，在此基础上对照组给予振动排痰仪联合异丙托溴铵雾化吸入治疗，观察组在对照组基础上给予沙丁胺醇。比较两组临床效果、恢复状况指标（肺部体征缓解时间、咳嗽缓解时间、住院时间）、排痰量、肺功能[50%肺容量的最大呼气流量占预计值的百分比（MEF50%pred）、用力肺活量（FVC），并计算第1秒用力呼气容积占用力肺活量的百分比（FEV1/FVC%）]、炎症指标[白细胞介素-6（IL-6）、血清降钙素原（PCT）、血清淀粉样蛋白A（SAA）]、动脉血气指标[血氧分压（PaO2）、血二氧化碳分压（PaCO2）、血氧饱和度（SaO2）]。结果：观察组治疗总有效率为92.11%，高于对照组的73.68%，差异有统计学意义（P<0.05）。观察组肺部体征缓解时间、咳嗽缓解时间、住院时间均短于对照组，差异均有统计学意义（P<0.05）。治疗3、7 d后，观察组日排痰量均多于对照组，差异均有统计学意义（P<0.05）。治疗后，观察组MEF50%pred、FVC、FEV1/FVC%、PaO2、SaO2指标均高于对照组，观察组IL-6、PCT、SAA、PaCO2指标均低于对照组，差异均有统计学意义（P<0.05）。结论：振动排痰仪联合异丙托溴铵、沙丁胺醇雾化吸入在矽肺合并COPD患者治疗中应用良好。

【关键词】 振动排痰仪 异丙托溴铵 沙丁胺醇 矽肺 慢性阻塞性肺疾病

Application of Vibration Sputum-discharge Apparatus Combined with Ipratropium Bromide and Salbutamol for Aerosol Inhalation in the Treatment of Silicosis and COPD/JIAN Lingli， YANG Ye， YANG Xu， CHEN Shuangping. //Medical Innovation of China， 2024， 21（14）： -124

[Abstract] Objective： To explore the application of vibration sputum-discharge apparatus combined with Ipratropium Bromide and Salbutamol for aerosol inhalation in the treatment of silicosis and chronic obstructive pulmonary disease （COPD）. Method： A total of 76 patients with silicosis complicated with COPD were selected from General Hospital of Pingxiang Mining Group Co. from June 2021 to June 2023 for the study. According to the order of admission， patients were divided into observation group and control group by computer random number grouping method， with 38 cases in each group. All patients received routine anti infection and symptomatic treatment for asthma and spasms， the control group was treated with vibration sputum-discharge apparatus and Ipratropium Bromide on this basis， while observation group was additionally treated with Salbutamol on basis of control group. The clinical effieacy， recovery indexes （remission time of lung signs and cough， hospitalization time）， sputum output， pulmonary function [the percentage of maximalmid-expiratory flow velocity in vital capacity 50% to predicted value （MEF50%pred）， forced vital capacity （FVC）， the percentage of forced expiratory volume in 1 second to forced vital capacity （FEV1/FVC%）]， inflammatory indexes [interleukin-6 （IL-6）， procalcitonin （PCT）， serum amyloid A （SAA）]， arterial blood gas indexes [partial pressure of oxygen （PaO2）， partial pressure of carbon dioxide （PaCO2）， blood oxygen saturation （SaO2）] and occurrence of adverse reactions in the two groups were compared. Result： The total effective rate of treatment in observation group was 92.11%， which was higher than 73.68% in control group， the difference was statistically significant （P<0.05）. The remission time of lung signs and cough， and hospitalization time in observation group were shorter compared to those the control group， the differences were statistically significant （P<0.05）. After 3， 7 d of treatment， daily sputum output in observation group were than those in control group， the differences were statistically significant （P<0.05）. After treatment， MEF50%pred， FVC， FEV1/FVC%， PaO2 and SaO2 in observation group were higher than those in control group， the differences were statistically significant （P<0.05）; while IL-6， PCT， SAA and PaCO2 in observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： Curative effect of vibration sputum-discharge apparatus combined with Ipratropium Bromide and Salbutamol for aerosol inhalation is good in patients with silicosis and COPD.

[Key words] Vibration sputum-discharge apparatus Ipratropium Bromide Salbutamol Silicosis Chronic obstructive pulmonary disease

First-author's address： Department of Respiratory and Critical Care Medicine， General Hospital of Pingxiang Mining Group Co.， Pingxiang 337000， China

doi：10.3969/j.issn.1674-4985.2024.14.029

矽肺是一种较为常见的职业病，约占尘肺病的50%，患者多为长期吸入有毒、有害物质所致。患者早期多无明显症状，因此易被忽视，但随着病情可发展至肺功能障碍[1]。慢性阻塞性肺疾病（COPD）患者表现为反复咳嗽、气喘，是矽肺最常见的合并症类型之一，而矽肺合并COPD患者自身排痰能力较弱，浓痰长期阻塞气道，易导致患者呼吸困难等病症加剧，因此促进排痰是治疗的关键环节之一[2]。……