煤工尘肺雾化吸入α-糜蛋白酶和可必特的临床疗效观察
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摘要
目的探讨煤工尘肺合并肺功能损伤,临床症状处于平稳期的患者吸入α-糜蛋白酶及可必特(M受体阻滞剂与β2受体激动剂联合制剂)的疗效。方法随机抽取肺功能损伤患者123人,随机分成3组,能顺利完成试验者115人,其中,可必特组(35例)、α-糜蛋白酶组(48例)和对照组(32例)。3组患者同期开始接受雾化吸入治疗,可必特组每次雾化吸入可必特2.5 ml加3.5 ml注射用水,α-糜蛋白酶组每次雾化吸入α-糜蛋白酶4 000 U加6 ml注射用水,对照组雾化吸入注射用水6 ml。连续5 d给药,每天2次,每次15 min。分别于试验前及试验后测定受试者肺功能(FEV1、FVC、EVC、FEF25%～75%、MEF75%、MEF50%),以及受试者临床症状积分、平地6 min走距离等指标,及时记录药物不良反应,评估治疗依从性。结果用药前各组临床症状积分、6 min走距离、肺功能各项指标的差别均无统计学意义。治疗后可必特组:临床症状积分下降、6 min走距离增加与治疗前比较,差异具有统计学意义(均P<0.01),肺功能指标FEV1、MEF75%、EVC较治疗前明显改善(均P<0.05);糜蛋白酶组:6 min走距离增加与治疗前比较,差异有统计学意义(P<0.05),临床症状积分与治疗前比较,差异无统计学意义,肺功能指标EVC较治疗前明显增加(P<0.01)。对照组:临床症状积分、6 min走距离与治疗前比较差异无统计学意义(均P>0.05),治疗后较治疗前FEF25%～75%(P<0.01)、MEF50%(P<0.05),2项肺功能指标差异有统计学意义。3组用药疗效比较:对于EVC指标,糜蛋白酶组疗效优于对照组,P<0.05;可必特组FEV1、FEF25%～75%、MEF50%(均P<0.05)、MEF75%、EVC(P<0.01),5项肺功能指标改善程度优于对照组;可必特组对于MEF75%(P<0.01)、EVC(P<0.05)改善程度优于糜蛋白酶组。结论可必特既对小气道功能障碍改善,又对阻塞性通气功能障碍、限制性通气功能障碍指标作用显著,且不良反应较小,依从性好,煤工尘肺患者所罹患的阻塞性通气功能障碍、限制性通气功能障碍或混合性通气功能障碍患者雾化吸入可必特是较为理想的治疗方法;糜蛋白酶针对限制性通气功能障碍指标有非常显著的疗效,不良反应小,较易被患者接受,是限制性通气功能障碍患者改善肺通气功能治疗方法之一;注射用水对小气道功能有损伤,不宜单纯应用。
[Objective]To study the therapeutic effect of α-chymotrypsin and Combivent(M-receptor blocker combined with β2 receptor agonist) by aerosol inhalation in treatment of coal workers' pneumoconiosis(CWP) patients who were complicated with pulmonary dysfunction and had stable clinical symptoms.[Methods]Among 123 patients with pulmonary dysfunction,115 patients had completed the trial,and they were randomly divided into the Combivent group(35 cases),α-chymotrypsin group(48 cases) and the control group(32 cases).Three groups were treated with aerosol inhalation,Combivent group was given Combivent 2.5 ml with injection water 3.5 ml,α-chymotrypsin group was given α-chymotrypsin 4 000 U with injection water 6 ml,and the control group was given injection water 6 ml,for 5 days,twice daily,15 min for every time.The pulmonary function(FEV-1,FVC,EVC,FEF25%-75%,MEF75% and MEF 50%),clinical symptom scores and six minute walking distance of patients before and after treatment were observed,the adverse reactions were recorded,and the compliance was evaluated.[Results]Before treatment,there was no significant difference in clinical symptom scores,six minute walking distance and pulmonary function indexes among three groups.After treatment,the clinical symptom scores in Combivent group were lower than those before treatment,and six minute walking distance was higher than that before treatment(both P<0.01).FEV-1,MEF75% and EVC had improved significantly compared with before treatment(all P<0.05).In α-chymotrypsin group,six minute walking distance was higher than that before treatment(P<0.05),there was no significant difference in clinical symptom scores,and EVC had improved significantly compared with before treatment(P<0.01).In the control group,there was no significant difference in clinical symptom scores and six minute walking distance between before and after treatment(both P>0.05).FEF25%-75%(P<0.01) and MEF50%(P<0.05) had improved significantly compared with before treatment.The effect of EVC inα-chymotrypsin group was better than that in the control group(P<0.05).The improvement of FEV-1(P<0.05),FEF25%-75%(P<0.05),MEF 50%(P<0.05),MEF 75%(P<0.01) and EVC(P<0.01) in Combivent group were better than those in the control group.The improvement of MEF 75%(P<0.01) and EVC(P<0.05) in Combivent group was better than those in α-chymotrypsin group.[Conclusion]Combivent can improve the small airway dysfunction,obstructive ventilatory disorder and restrictive ventilation dysfunction,and has less adverse reactions and good compliance.Combivent by aerosol inhalation is an ideal treatment method for CWP patients with obstructive ventilatory disorder,restrictive ventilatory dysfunction and mixed ventilatory dysfunction.The α-chymotrypsin has significant effect on restrictive ventilatory dysfunction with less adverse reactions,and it is easy to be accepted by patients,which is one of treatment method for restrictive ventilatory dysfunction.The injection water may damage the small airway function,so it is inadvisable to application alone.
[Objective]To study the therapeutic effect of α-chymotrypsin and Combivent(M-receptor blocker combined with β2 receptor agonist) by aerosol inhalation in treatment of coal workers' pneumoconiosis(CWP) patients who were complicated with pulmonary dysfunction and had stable clinical symptoms.[Methods]Among 123 patients with pulmonary dysfunction,115 patients had completed the trial,and they were randomly divided into the Combivent group(35 cases),α-chymotrypsin group(48 cases) and the control group(32 cases).Three groups were treated with aerosol inhalation,Combivent group was given Combivent 2.5 ml with injection water 3.5 ml,α-chymotrypsin group was given α-chymotrypsin 4 000 U with injection water 6 ml,and the control group was given injection water 6 ml,for 5 days,twice daily,15 min for every time.The pulmonary function(FEV-1,FVC,EVC,FEF25%-75%,MEF75% and MEF 50%),clinical symptom scores and six minute walking distance of patients before and after treatment were observed,the adverse reactions were recorded,and the compliance was evaluated.[Results]Before treatment,there was no significant difference in clinical symptom scores,six minute walking distance and pulmonary function indexes among three groups.After treatment,the clinical symptom scores in Combivent group were lower than those before treatment,and six minute walking distance was higher than that before treatment(both P<0.01).FEV-1,MEF75% and EVC had improved significantly compared with before treatment(all P<0.05).In α-chymotrypsin group,six minute walking distance was higher than that before treatment(P<0.05),there was no significant difference in clinical symptom scores,and EVC had improved significantly compared with before treatment(P<0.01).In the control group,there was no significant difference in clinical symptom scores and six minute walking distance between before and after treatment(both P>0.05).FEF25%-75%(P<0.01) and MEF50%(P<0.05) had improved significantly compared with before treatment.The effect of EVC inα-chymotrypsin group was better than that in the control group(P<0.05).The improvement of FEV-1(P<0.05),FEF25%-75%(P<0.05),MEF 50%(P<0.05),MEF 75%(P<0.01) and EVC(P<0.01) in Combivent group were better than those in the control group.The improvement of MEF 75%(P<0.01) and EVC(P<0.05) in Combivent group was better than those in α-chymotrypsin group.[Conclusion]Combivent can improve the small airway dysfunction,obstructive ventilatory disorder and restrictive ventilation dysfunction,and has less adverse reactions and good compliance.Combivent by aerosol inhalation is an ideal treatment method for CWP patients with obstructive ventilatory disorder,restrictive ventilatory dysfunction and mixed ventilatory dysfunction.The α-chymotrypsin has significant effect on restrictive ventilatory dysfunction with less adverse reactions,and it is easy to be accepted by patients,which is one of treatment method for restrictive ventilatory dysfunction.The injection water may damage the small airway function,so it is inadvisable to application alone.
引文
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[2]Musk AW.Relationship between type of simple CWP and lung function[J].Brit J Indus Med,1981,38:313.
[3]欧阳若云,尹本义.糖皮质激素治疗慢性阻塞性肺病的研究[J].中华结核和呼吸杂志,1998,21(8):497-409.
[4]Oga T,Nishimura K,Tsukino M,et al.The effects of oxitropium bromideon exercise performance in patients with stable Chronic obstructive pul-monary diseade,A comparison of three different exercise tests[J].Am JRespir Crit care med,2000,161:1897-1901.
[5]赵彤彤.尘肺病人行氧气雾化吸入疗法的护理[J].家庭护理,2006,14(5):4.
[6]De Cock R.Ficker LA,Dart JG,et a1.Topical heparin in the treatmentof lingneous conjunctivitis[J].Ophthalmology,1995,102:1654.
[7]El-Kadi KN,Rawlings AV,Feinberg C,et al.Broad specificity alkalineproteases efficiently reduce the visual scaling associated with soap-in-duced xerosis[J].Arch Dermatol Res,2001,293:500-507.
[8]黄茂华,赵宪平,沈剑,等.糜蛋白酶临床应用进展[J].上海医药2005,26(10):462-464.
[9]周自永,王世祥.新编常用药物手册[M].3版.北京:金盾出版社,1998:787.
[10]刘宇师,冬侠.舒喘灵、丙酸培氯松、α糜蛋白酶联合雾化吸入佐治毛细支气管炎的疗效观察[J].基层医学论坛,2006,10(7):620-621.
[11]于虹,张茜,袁庆海.干扰素γ和糜蛋白酶雾化吸入治疗慢性支气管炎急性发作的临床观察[J].中国老年学杂志,2007,27(7):687-688.
[12]陈德伟,何宗明.糜蛋白酶、地塞米松雾化吸入治疗小儿支气管哮喘82例疗效观察[J].国际医药卫生导报,2007,13(16):110-111.
[13]陈育智.儿童支气管哮喘的诊断及治疗[M].北京:人民卫生出版社,2004:70.
[14]蔡柏蔷.呼吸内科学-高级医师案头丛书[M].北京:中国协和医科大学出版社,2000:325-346.
[15]石来军,孙洁.病毒唑、普米克、可必特联合雾化吸入治疗毛细支气管炎[J].郑阳医学院学报,2007,26(2):701.
[16]翁海霞.长期联合吸入异丙托溴胺与沙丁胺醇的老年慢性阻塞性肺疾病患者对支气管扩张剂的反应性观察[J].中国药物与临床,2005,5(5):360-362.
[17]张伟华,王建民,朱永军.可必特对COPD患者气道扩张作用观察[J].中原医刊,1998,25(6):5-6.
[18]李现东,吴雪雁,贾宗岭.长期应用可必特治疗慢性阻塞性肺疾病的临床观察[J].河南大学学报(医学版),2006,25(3):49-50.
[2]Musk AW.Relationship between type of simple CWP and lung function[J].Brit J Indus Med,1981,38:313.
[3]欧阳若云,尹本义.糖皮质激素治疗慢性阻塞性肺病的研究[J].中华结核和呼吸杂志,1998,21(8):497-409.
[4]Oga T,Nishimura K,Tsukino M,et al.The effects of oxitropium bromideon exercise performance in patients with stable Chronic obstructive pul-monary diseade,A comparison of three different exercise tests[J].Am JRespir Crit care med,2000,161:1897-1901.
[5]赵彤彤.尘肺病人行氧气雾化吸入疗法的护理[J].家庭护理,2006,14(5):4.
[6]De Cock R.Ficker LA,Dart JG,et a1.Topical heparin in the treatmentof lingneous conjunctivitis[J].Ophthalmology,1995,102:1654.
[7]El-Kadi KN,Rawlings AV,Feinberg C,et al.Broad specificity alkalineproteases efficiently reduce the visual scaling associated with soap-in-duced xerosis[J].Arch Dermatol Res,2001,293:500-507.
[8]黄茂华,赵宪平,沈剑,等.糜蛋白酶临床应用进展[J].上海医药2005,26(10):462-464.
[9]周自永,王世祥.新编常用药物手册[M].3版.北京:金盾出版社,1998:787.
[10]刘宇师,冬侠.舒喘灵、丙酸培氯松、α糜蛋白酶联合雾化吸入佐治毛细支气管炎的疗效观察[J].基层医学论坛,2006,10(7):620-621.
[11]于虹,张茜,袁庆海.干扰素γ和糜蛋白酶雾化吸入治疗慢性支气管炎急性发作的临床观察[J].中国老年学杂志,2007,27(7):687-688.
[12]陈德伟,何宗明.糜蛋白酶、地塞米松雾化吸入治疗小儿支气管哮喘82例疗效观察[J].国际医药卫生导报,2007,13(16):110-111.
[13]陈育智.儿童支气管哮喘的诊断及治疗[M].北京:人民卫生出版社,2004:70.
[14]蔡柏蔷.呼吸内科学-高级医师案头丛书[M].北京:中国协和医科大学出版社,2000:325-346.
[15]石来军,孙洁.病毒唑、普米克、可必特联合雾化吸入治疗毛细支气管炎[J].郑阳医学院学报,2007,26(2):701.
[16]翁海霞.长期联合吸入异丙托溴胺与沙丁胺醇的老年慢性阻塞性肺疾病患者对支气管扩张剂的反应性观察[J].中国药物与临床,2005,5(5):360-362.
[17]张伟华,王建民,朱永军.可必特对COPD患者气道扩张作用观察[J].中原医刊,1998,25(6):5-6.
[18]李现东,吴雪雁,贾宗岭.长期应用可必特治疗慢性阻塞性肺疾病的临床观察[J].河南大学学报(医学版),2006,25(3):49-50.