内科

目的探讨噻托溴铵联合布地奈德吸入治疗哮喘-慢阻肺重叠综合征患者的临床效果。方法将2015年1月至2016年12月在东莞市人民医院治疗的哮喘-慢阻肺重叠综合征患者90例随机分为对照组和研究组，每组45例。在常规治疗的基础上，对照组患者吸入布地奈德治疗，研究组患者在对照组治疗基础上吸入噻托溴铵治疗。检测比较两组患者治疗前后的肺功能、症状改善情况、急性加重次数、活动耐力以及并发症的发生情况。结果治疗后，两组患者FEV1、IC/TLC均升高、RV/TLC均降低，研究组患者FEV1、IC/TLC高于对照组、RV/TLC低于对照组，差异有统计学意义（P＜0.01）；两组患者ACT评分均显著升高、CAT评分均显著降低，研究组患者ACT评分高于对照组、CAT评分低于对照组，差异有统计学意义（P＜0.01）。治疗后1年，两组患者的急性加重次数均显著减少、研究组患者急性加重次数少于对照组（P＜0.01）；治疗后6个月，两组患者的6 min平均步行距离均显著增加，研究组患者的6 min平均步行距离大于对照组（P＜0.01）。治疗过程中研究组患者并发症发生率（8.9%）显著低于对照组（31.1%），差异有统计学意义（P＜0.01）。结论噻托溴铵联合布地奈德吸入治疗哮喘-慢阻肺重叠综合征患者，可有效改善患者的肺功能及临床症状，增强活动耐力，降低并发症的发生率，改善预后，值得临床推广应用。

ObjectiveTo investigate the clinical effect of tiotropium bromide combined with budesonide inhalation in the treatment of patients with asthma-COPD overlap syndrome（ACOS）. Methods90 ACOS patients treated in Dongguan People′s Hospital from January 2015 to December 2016 were randomly divided into control group and study group, 45 cases in each group. On the basis of routine treatment, the control group inhaled budesonide, and the study group were treated with tiotropium bromide on the basis of the control group. The pulmonary function, symptom improvement, acute exacerbation, complications were compared the two groups before and after treatment between. ResultsAfter treatment, FEV1 and IC/TLC increased and RV/TLC decreased in all two groups. The FEV1 and IC/TLC in the study group were higher than those in the control group and RV/TLC was lower than that in the control group, the difference was statistically significant (P＜0.01). ACT scores of the two groups were increased, CAT scores were reduced. The ACT score of the study group was higher than that of the control group, and the CAT score was lower than that of the control group, the difference was statistically significant (P＜0.01). The number of acute exacerbations in the two groups decreased in 1 years′ treatment, and the number of acute aggravation in the study group was less than that of the control group (P＜0.01). After 6 months of treatment, the average walking distance of 6min in the two groups increased, and the average walking distance of the 6min in the study group was greater than that of the control group (P＜0.01). The incidence of complications in the study group (8.9%) was lower than that of the control group (31.1%) during the treatment, and the difference was statistically significant (P＜0.01). ConclusionTiotropium bromide combined with budesonide inhalation in the treatment of ACOS patients can effectively improve the pulmonary function and clinical symptoms, enhance the activity endurance, reduce the incidence of complications, and improve the prognosis. It is worthy of clinical application.