【摘要】 目的探讨使用长效抗胆碱能药物噻托溴铵治疗成人哮喘6周前后的自主神经功能改变及临床效果。方法 45例非急性发作的中度哮喘患者随机分为A组15例:噻托溴铵粉吸入剂+丙氟酸氟替卡松气雾剂组;B组15例:吸入沙美特罗替卡松干粉剂组;C组15例:噻托溴铵粉吸入剂+沙美特罗替卡松干粉剂。观察三组患者治疗前后心率变异性、肺功能指标及症状控制情况。结果①治疗6周后,A组的HF、PNN50降低,与用药前对比差异有统计学意义(P<0.05),LF、SDANN增高,差异无统计学意义(P>0.05);B组的HF、PNN50降低,LF、SDANN增高,与用药前对比差异均无统计学意义(P>0.05);C组的HF、PNN50降低,LF、SDANN增高,与用药前对比差异均有统计学意义(P<0.05);②三组的日间、夜间症状评分较用药前有所降低,使用短效β2-受体激动剂的次数减少,肺功能中的FEV1、FEV1%较用药前改善,三组与治疗前对比差异均有统计学意义;③组间对比得出心率变异性的定量分析指标(HF、PNN50、LF、SDANN)A组与B组,B与C组有统计学意义(P<0.05),A组与C组差异无统计学意义(P>0.05);肺功能中的FEV1、FEV1%显示A组与B组无统计学意义(P>0.05),而A组与C组、B组与C组差异均有统计学意义(P<0.05);日间、夜间症状评分、使用短效β2-受体激动剂的次数显示A组与B组差异无统计学意义(P>0.05),A组与C组,B组与C组差异有统计学意义(P<0.05)。长效抗胆碱能药物噻托溴铵粉吸入剂联合糖皮质激素可以降低HF、PNN50,使迷走神经兴奋性降低,与长效β2-受体激动剂(LABA)联合糖皮质激素相比在改善肺功能中FEV1、FEV1%值,减少使用短效β2-受体激动剂的次数,降低哮喘症状评分方面,效果相当。结论以上三种药物联合使用在改善肺功能、降低心率变异性、降低哮喘症状评分及使用短效β2-受体激动剂次数等方面均表现出更明显的优势。更多还原

【Abstract】 Objective To observe the efficacy and the changes of autonomic nervous systemon using heart rate variability in the asthma patients before and after 6 weeks anticholinergic drugs treatment.Method 45 non-acute exacerbation moderate adult asthma patients were divided into three groups randomly.It was evaluated that the addition of tiotropium bromide to an inhaled glucocorticoid in the treatment group,A(n=15),as compared with the addition of salmeterol group,B(n=15) and the combined inhalation group,C(n=15).Serial measurements of heart rate variability,lung function and symptom control were performed.Result ①After 6 weeks of treatment,HF and PNN50 of group A were decreased.There was statistically significant difference between before and after the treatment,(P<0.05).The LF and SDANN of group A was increased.There was no statistically significant difference between before and after the treatment(P>0.05).HF and PNN50 of group B were decreased,LF and SDANN were increased.There was no statistically significant difference between before and after the treatment(P>0.05).HF and pNN50 of group C were decreased,LF and SDANN were increased.There was statistically significant difference(P<0.05);② The daytime and nighttime symptom scores,the times of using a short-acting beta 2-agonist of three groups were lowered after the treatment.The FEV 1,FEV 1 % were improved after the treatment.There was statistically significant difference(P<0.05);③ The quantitative indexes of heart rate variability were compared in groups.There was statistically significant difference between group A and group B,group B and group C,there was no statistically significant difference between group A and group C.The FEV 1 and FEV 1 % showed no statistically significant group A and group B,but there was statistically significant difference between group A and group C,group B and group C.The daytime and nighttime symptom scores,the times of using a short-acting beta 2-agonist showed no statistically significant between group A and group B,but there was statistically significant difference between group A and group C,group B and group C.The addition of the long-acting anticholinergic drugs tiotropium bromide powder to an inhaled glucocorticoid can reduce HF,PNN50 and the vagus nerve excitability,comparing with the addition of the long acting β agonist(LABA) to an inhaled glucocorticoid.Its effects appeared to be equivalent in improving lung function FEV 1,FEV 1 % values,reducing the times of using short-acting beta 2-agonist and asthma symptom scores.Conclusion All three of these drugs used in combination to improve lung function,reduce heart rate variability,drop the asthma symptom scores and the times of using a short-acting beta 2-agonists are showed more obvious advantages.更多还原