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1、 摘要目的 观察舒利迭（沙美特罗/氟替卡松吸入剂）不同剂 量对重度（gold iii 级）稳定期慢性阻塞性肺疾病（copd）不同表 型（普通型与伴气道高反应型）的临床疗效。方法 选取 120 例稳 定期重度 copd 患者，其中伴气道高反应性者 60 例，随机分成两组， 各30 例，普通型者 60 例，也均分成两组，各 30 例，设立一个对 照组给予口服茶碱缓释片（0.1mg 日两次口服）及酮替酚片（1mg 一日两次口服），三个观察组，给予吸入不同剂量的舒利迭，疗程 均为 3 个月。治疗前后测定 1 秒量占预计值百分比（fevl%）及用 力肺活量占预计值的百分比（fev1%）、1 秒率（fev
2、1/fvc ）。结果 102 例患者最终完成试验，对照组治疗前后肺功能 fvc%、fevl%、 fev1/fvc 有所改善，但无统计学意义（p 0.05 ）,三观察组肺功能 改善均较对照组明显改善（pv 0.05），且实验组间伴气道高反应性 者改善明显。结论沙美特罗/氟替卡松吸入剂治疗 copd 疗效肯定， 对伴气道高反应性者疗效更好。 关键词舒利迭；慢性阻塞性肺疾病；气道高反应性；表型 中图分类号r563.9 文献标识码b 文章编 号1673-9701 （2011） 36-158-03 clinical observation of the efficacy of inhaling salm
3、eterol and differe nt doses of fluticas one powder for the treatme nt of severe stable copd with differe nt phe no type 医一论文发袤专家一 不同剂量舒利迭对不同表型重度稳定期 医一论文发袤专家一 J中国黠斛网中国黠斛网 fwww.qikanwang. nel COPDF临床疗效研 J中国黠斛网中国黠斛网 fwww.qikanwang. nel che n kai zhai xiumei zhe ng li people s hospital of yongcheng city
4、 in henan province yon gche ng 476600, chi na. abstract objective to observe on seretide (salmeterol/fluticas one in halati on) at differe nt doses on severe (gold grade) the stable phase of chronic obstructive pul monary disease (copd) with differe nt phe no types (com mon type with high reacti on
5、of airway type) cli nical efficacy. methods all of 120 patients with severe stable copd, in which 60 cases has airway hyperresp on sive ness, were ran domly divided into 2 groups(30 cases each); the remaining 60 cases were ordinary type, they were divided into 2 more groups(30 cases each). from the
6、above 4 groups, a control group was set up by give n oral theophylli ne susta in ed-released tablets(0.1g two times a day orally) and ketotife n fumarate tablets (1mg two times a day orally). the remaining 3 groups were set up as observati on group by give n differe nt doses of seretide in halati on
7、. the treatme nt course casted for 3 mon ths. a second volume determined before and after treatment(fev1%) and fvc% predicted the percentage value (fevl%), a second rate (fev1/fvc). results all of 102 patients completed the final test. the control group of lung function before and after 论文发表专家一 J中国学
8、木期中国学木期刊厕刊厕 %ww .q i kanwang ,nei therapy, fevl%, fevl fvc%/fvc had improved but there was no statistical sig ni fica nce(p0.05); three remai ning observati on group improved lung fun cti on were sig ni fica ntly improved compared with the con trol group(p0.05) and the experime ntal group with airwa
9、y hyperresp on sive ness were improved obviously. con clusi on salmeterol/fluticas one in halati on curative effect in the treatme nt of copd, with airway hyperresp on sive ness effect is better. key words seretide; chronic obstructive pul monary disease; airway hyperresp on sive ness ; phe no type
10、慢性阻塞性肺疾病（chronic obstructive pulmoriary disease , copd）的患病率在我国占 40 岁以上人群的 8.2 %1，造成巨大的 社会和经济负担。为了提高此类患者的生活质量，世界各国学者都 在不断地探索，至今仍无特效的药物治疗，现在的治疗方法借用哮 喘的治疗方法，对重度慢阻肺患者，慢性阻塞性肺疾病全球倡议 （gold ）建议规律使用长效B 2 受体激动剂（laba ）,若反复急性加 重，则要联合吸入糖皮质激素2。舒利迭是长效B 2 受体激动剂 沙美特罗和吸入型糖皮质激素氟替卡松的复合剂型，使用方便，吸 收率高，患者依从性好。其中沙美特罗有松弛呼吸道平滑肌、增加 纤毛清除功能、抑制炎症细胞释放介质、降低血管通透性等作用。 氟替卡松是吸入型糖皮质激素的典型代表，具有高的糖皮质激素亲 和力、咼的局部抗炎活性、咼的糖皮质激素受体特异性、咼的首过