CAJ | 학술논문

目的：了解完全控制哮喘患者的用药情况,并探讨不同用药情况对哮喘急性发作的影响。方法选取2007年1月—2013年12月在武汉大学人民医院呼吸内科门诊就诊或治疗后出院的501例完全控制哮喘患者为研究对象。根据用药情况,以单纯采用吸入药物进行治疗的患者为吸入治疗组,以联合采用口服药物和吸入药物进行治疗的患者为联合治疗组。入组后两组患者均维持达到完全控制时的治疗方案,随访24周。记录患者随访期间的临床表现、哮喘控制测试量表( ACT)得分、肺功能以及因哮喘急性发作退出试验的病例数、存在1次及以上急性发作的病例数、累计急性发作次数。结果共有371例患者按要求完成了24周随访,吸入治疗组和联合治疗组分别为208例(占56．1%)和163例(占43．9%)。两组完成24周随访患者的性别、平均年龄、第1秒用力呼气容积( FEV1)占预计值百分比、第1秒用力呼气容积占用力肺活量百分比( FEV1/FVC)及FEV1改善率比较,差异均无统计学意义( P>0．05)；而25%~75%用力肺活量时呼吸流速(FEF25%~75%)占预计值百分比比较,差异有统计学意义(P<0．05)。163例联合采用口服药物和吸入药物进行治疗的患者中,131例(占80．4%)的口服药物为茶碱缓释片,124例(占76．1%)为吸入大剂量糖皮质激素未获得完全控制者。吸入治疗组和联合治疗组因哮喘急性发作退出试验的病例数比较,差异有统计学意义(P<0．05)；完成24周随访的患者中,急性发作次数≥1次的病例数比较,差异有统计学意义(P<0．05)；累计急性发作次数比较,差异亦有统计学意义(P<0．05)。结论吸入药物疗法仍然是目前控制哮喘的主要治疗方法,对于单纯采用吸入疗法无法达到完全控制的患者,可适当联合采用口服药物进行治疗,茶碱缓释片是目前常用的口服治疗哮喘药物。与单纯采用吸入药物进行治疗的患者相比,联合采用口服药物和吸入药物进行治疗的患者哮喘急性发作水平较低。目的：瞭解完全控製哮喘患者的用藥情況,併探討不同用藥情況對哮喘急性髮作的影響。方法選取2007年1月—2013年12月在武漢大學人民醫院呼吸內科門診就診或治療後齣院的501例完全控製哮喘患者為研究對象。根據用藥情況,以單純採用吸入藥物進行治療的患者為吸入治療組,以聯閤採用口服藥物和吸入藥物進行治療的患者為聯閤治療組。入組後兩組患者均維持達到完全控製時的治療方案,隨訪24週。記錄患者隨訪期間的臨床錶現、哮喘控製測試量錶( ACT)得分、肺功能以及因哮喘急性髮作退齣試驗的病例數、存在1次及以上急性髮作的病例數、纍計急性髮作次數。結果共有371例患者按要求完成瞭24週隨訪,吸入治療組和聯閤治療組分彆為208例(佔56．1%)和163例(佔43．9%)。兩組完成24週隨訪患者的性彆、平均年齡、第1秒用力呼氣容積( FEV1)佔預計值百分比、第1秒用力呼氣容積佔用力肺活量百分比( FEV1/FVC)及FEV1改善率比較,差異均無統計學意義( P>0．05)；而25%~75%用力肺活量時呼吸流速(FEF25%~75%)佔預計值百分比比較,差異有統計學意義(P<0．05)。163例聯閤採用口服藥物和吸入藥物進行治療的患者中,131例(佔80．4%)的口服藥物為茶堿緩釋片,124例(佔76．1%)為吸入大劑量糖皮質激素未穫得完全控製者。吸入治療組和聯閤治療組因哮喘急性髮作退齣試驗的病例數比較,差異有統計學意義(P<0．05)；完成24週隨訪的患者中,急性髮作次數≥1次的病例數比較,差異有統計學意義(P<0．05)；纍計急性髮作次數比較,差異亦有統計學意義(P<0．05)。結論吸入藥物療法仍然是目前控製哮喘的主要治療方法,對于單純採用吸入療法無法達到完全控製的患者,可適噹聯閤採用口服藥物進行治療,茶堿緩釋片是目前常用的口服治療哮喘藥物。與單純採用吸入藥物進行治療的患者相比,聯閤採用口服藥物和吸入藥物進行治療的患者哮喘急性髮作水平較低。
목적：료해완전공제효천환자적용약정황,병탐토불동용약정황대효천급성발작적영향。방법선취2007년1월—2013년12월재무한대학인민의원호흡내과문진취진혹치료후출원적501례완전공제효천환자위연구대상。근거용약정황,이단순채용흡입약물진행치료적환자위흡입치료조,이연합채용구복약물화흡입약물진행치료적환자위연합치료조。입조후량조환자균유지체도완전공제시적치료방안,수방24주。기록환자수방기간적림상표현、효천공제측시량표( ACT)득분、폐공능이급인효천급성발작퇴출시험적병례수、존재1차급이상급성발작적병례수、루계급성발작차수。결과공유371례환자안요구완성료24주수방,흡입치료조화연합치료조분별위208례(점56．1%)화163례(점43．9%)。량조완성24주수방환자적성별、평균년령、제1초용력호기용적( FEV1)점예계치백분비、제1초용력호기용적점용력폐활량백분비( FEV1/FVC)급FEV1개선솔비교,차이균무통계학의의( P>0．05)；이25%~75%용력폐활량시호흡류속(FEF25%~75%)점예계치백분비비교,차이유통계학의의(P<0．05)。163례연합채용구복약물화흡입약물진행치료적환자중,131례(점80．4%)적구복약물위다감완석편,124례(점76．1%)위흡입대제량당피질격소미획득완전공제자。흡입치료조화연합치료조인효천급성발작퇴출시험적병례수비교,차이유통계학의의(P<0．05)；완성24주수방적환자중,급성발작차수≥1차적병례수비교,차이유통계학의의(P<0．05)；루계급성발작차수비교,차이역유통계학의의(P<0．05)。결론흡입약물요법잉연시목전공제효천적주요치료방법,대우단순채용흡입요법무법체도완전공제적환자,가괄당연합채용구복약물진행치료,다감완석편시목전상용적구복치료효천약물。여단순채용흡입약물진행치료적환자상비,연합채용구복약물화흡입약물진행치료적환자효천급성발작수평교저。
Objective To investigate the medication of patients with totally controlled asthma, and explore the effects of different medications on acute episoded asthma. Methods We enrolled 501 patients with totally controlled asthma who received treatment in or discharged from the Department of Respiratory Medicine of Renmin Hospital of Wuhan University from January 2007 to December 2013. According to medication, the patients who were purely administrated with inhaled drugs were assigned into inhalation therapy group, and the patients who were administrated with both oral drugs and inhaled drugs were assigned into combined group. The two groups were given the same therapies when complete control was achieved. During the follow-up for 24 weeks, we recorded clinical manifestations, ACT score, pulmonary function, the number of cases who quitted the study due to acute episoded asthma, the number of cases with one or more than one times of acute episode asthma and the number of times of acute attack. Results A total of 371 patients completed 24 weeks of follow-up as required, with 208 (56. 1%) for inhalation therapy group and 163 ( 43. 9%) for combined group. The two groups were not significantly different ( P >0. 05 ) in gender, average age, the ratio of FEV1 to the predicted value, FEV1/FVC and the improvement rate of FEV1 of the patients who completed the 24 weeks′follow-up; the two groups were not significantly different in the ratio of FEF25% ~75% to predicted value ( P<0. 05) . Among the 163 patients who were administrated with both oral drugs and inhaled drugs, 131 (80. 4%) were orally administrated with theo - dur, and 124 ( 76. 1%) patients inhaled high - dose glucocorticoids but were not completely controlled. The two groups were significantly different ( P <0. 05 ) in the number of patients who quitted study due to acute episoded asthma, the number of patients who had times of acute episoded asthma≥1 and the accumulated number of times of acute episode among the patients who completed 24 weeks of follow -up. Conclusion Inhalation therapy is still the primary therapy for the asthma control. For patients who are only administrated with inhalation therapy but cannot be completely controlled, the combined use of oral drugs could be considered. Theo-dur is the common oral medication for asthma treatment. Compared with the patients who only take inhaled drug, the patients who take both oral drugs and inhaled drugs have low level in acute episoded asthma.