气道廓清联合雾化吸入对慢性阻塞性肺疾病疗效的观察

关键词：气道廓清  雾化吸入  震荡呼气正压  慢性阻塞性肺疾病

Keywords:airway clearance  inhalation  oscillatory positive expiratory pressure  chronic obstructive pulmonary disease

摘要：

      摘要 目的：明确气道廓清联合雾化吸入对慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）的临床疗效。 方法：本研究是一项前瞻性随机对照干预研究。纳入在2021年1月至12月期间就诊于广州医科大学附属第一医院的40例COPD稳定期患者，按照计算机生成的随机序列分为廓清后吸药组（AIG）、吸药后廓清组（IAG）和对照组(CG, 单纯吸药组）。最终有33例患者完成研究，7例退出研究。三组在给予常规药物治疗基础上，AIG使用震荡呼气正压（OPEP）装备治疗后吸入雾化药物，IAG在吸入雾化药物后使用OPEP装备治疗，CG仅使用吸入雾化药物治疗。分别于在基线、治疗12周和治疗24周后评估患者的6min步行距离（6-min walk distance， 6MWD）、呼吸困难、咳嗽、咳痰量表（brief core schema scales， BCSS）评分、COPD评估测试问卷（COPD assessment test， CAT）评分和临床COPD问卷（clinical COPD questionnaire， CCQ）评分的情况。 结果：治疗24周后，AIG的6MWD、BCSS评分、CAT评分和CCQ总分较基线时均有改善（P＜0.05），IAG的BCSS评分较基线时有改善（P＜0.05），AIG的6MWD、CCQ总分和CCQ功能评分的改善平均数均优于CG（P＜0.05），三组的BCSS评分和CAT评分的改善平均数，以及完成率均无显著性差异（P＞0.05）。治疗期间未发生OPEP装备相关不良事件报告。 结论：气道廓清联合雾化吸入使药物效果得到增强，进一步提高运动耐力，并改善健康相关生活质量，尤其对功能方面改善更具优势，但在改善呼吸道症状上疗效不明显。

Abstract:

      Abstract Objective： To clarify the clinical effect of airway clearance combined with aerosol inhalation on chronic obstructive pulmonary disease （COPD）. Method： This was a prospective， randomized， controlled intervention study. Forty patients with stable COPD at the First Affiliated Hospital of Guangzhou Medical University between January to December 2021 were enrolled and randomized into an airway clearance before inhalation group （AIG），an inhalation before airway clearance（IAG） and a control group（CG）. Thirty-three participants finally completed the study with eleven in each group. Three groups were given therapy based on conventional drug. AIG were also given oscillating positive expiratory pressure（OPEP） therapy before inhaling drugs，IAG were given inhaling drugs before oscillating positive expiratory pressure（OPEP） therapy， CG were only given inhaling drugs. Patients were evaluated at baseline， 12 and 24 weeks after intervention for 6-minute Walking Distance（6MWD），Breathlessness，Cough， and Sputum Scale（BCSS），COPD Accessment Test（CAT） and Clinical COPD Questionnaire（CCQ）. Result： After 24 weeks of intervention， 6MWD， BCSS score， CAT score and CCQ score were significantly improved compared to baseline in AIG（P＜0.05）. BCSS score was significantly improved compared to baseline in IAG（P＜0.05）. After 24 weeks of treatment， the mean changes of 6MWD， CCQ total score and CCQ functional score were significantly better in AIG than CG（P＜0.05）. No significant differences were found in the mean changes of BCSS score， CAT score and completion rate among the three groups in 24 weeks intervention（P＞0.05）. No OPEP equipment-related adverse events were reported during the intervention. Conclusion： Airway clearance combined with aerosol inhalation enhance the drug effect， improving exercise endurance and health-related quality of life， especially in functional improvement. However, there was no significant difference in the efficacy of respiratory symptoms.