pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2007-0-3-56-65pulmo-1928Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESЭффективность комбинированной терапии ингаляционными β2-агонистами и антихолинергическими препаратами при тяжелом обострении хронической обструктивной болезни легких: рандомизированное контролируемое исследованиеEffects of combined therapy with nebulized β2-agonist and anticholinergics in severe exacerbation of chronic obstructive pulmonary disease. A randomized controlled trialАвдеевС. Н.AvdeevS. N.

г. Москва

НуралиеваГ. С.NuralievaG. S.

г. Москва

БатынС. З.BatynS. Z.

г. Москва

СуточниковаО. А.SoutochnikovaO. A.

г. Москва

ЧучалинА. Г.ChuchalinA. G.

г. Москва

ФГУ НИИ пульмонологии РосздраваRussian Federation200728062007035665Copyright © Авдеев С.Н., Нуралиева Г.С., Батын С.З., Суточникова О.А., Чучалин А.Г., 20072007Авдеев С.Н., Нуралиева Г.С., Батын С.З., Суточникова О.А., Чучалин А.Г.Avdeev S.N., Nuralieva G.S., Batyn S.Z., Soutochnikova O.A., Chuchalin A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1928

Целью исследования явилось сравнение двух схем небулайзерной терапии — комбинацией сальбутамола и ипратропиума и монотерапии сальбутамолом — у больных с тяжелым обострением ХОБЛ. Исследование носило проспективный рандомизированный контролируемый слепой характер. Критериями включения в исследование были: тяжелое обострение ХОБЛ (усиление одышки; ОФВ1 < 1 л или менее 35 %долж. ; SpO2 < 92 %; ЧДД > 24 мин–1); возраст > 45 лет; стаж курения > 10 пачко-лет; отсутствие потребности в инвазивной рес пираторной поддержке. В исследование было включено 50 больных ХОБЛ (M: Ж = 41: 9, средний возраст 68 лет; средний ОФВ1 0,72 л, среднее PaO2 46 мм рт. ст.). Методом рандомизации больные были разделены на 2 группы: 1) небулайзерная терапия комбинацией саль бутамола 2,5 мг и ипратропиума 500 мкг каждые 4 ч в течение 7 дней (n = 26); 2) небулайзерная терапия сальбутамолом 2,5 мг каждые 4 ч в течение 7 дней (n = 24). Все больные также получали пероральные кортикостероиды, антибиотики, кислород и неинвазивную вентиляцию легких (при необходимости). Пациенты обеих групп были сравнимы между собой по демографическим, функциональным и газометрическим показателям. В обеих группах больных наблюдалось значительное улучшение параметров ОФВ1 , ФЖЕЛ и емкости вдоха, но комбинированная терапия, по сравнению с монотерапией сальбутамолом, приводила к более быстрому улучшению ФЖЕЛ (через 1 сут терапии: 1,90 ± 0,51 л vs 1,61 ± 0,50 л, р = 0,048; через 3 с: 2,00 ± 0,51 л vs 1,67 ± 0,49 л, р = 0,024) и улучшению емкости вдо ха (через 1 сут: 1,67 ± 0,39 л vs 1,38 ± 0,37 л, р = 0,010; через 3 сут: 21,77 ± 0,51 л vs 1,44 ± 0,40 л, р = 0,015). Уменьшение одышки (визу альная аналоговая шкала) также было достигнуто более быстро у больных, принимавших сальбутамол и ипратропиум (через 1 сут: 32 ± 13 мм vs 42 ± 15 мм, р = 0,019; через 3 сут: 26 ± 11 мм vs 33 ± 13 мм, р = 0,045). Потребность в назначении дополнительных ингаляций сальбутамола была выше у больных группы монотерапии (5,6 ± 3,5 против 1,3 ± 1,5 ингаляций на одного больного за 7 дней, p < 0,01). Между группами больных не было отмечено различий по таким параметрам, как ЧДД, ЧСС, PaO2 (кроме более значимого прироста PaO2 в 1 й группе через 1 сут терапии, р = 0,019), PaCO2, pH, и другим показателям. Частота развития побочных эффектов оказалась сходной в обеих группах. У больных с тяжелым обострением ХОБЛ небулайзерная терапия сальбутамолом и ипратропиумом более эффективна, чем монотерапия сальбутамолом.

The aim of the study was to compare the efficacy of nebulized salbutamol and ipratropium with nebulized salbutamol alone in patients with severe exacerbation of COPD. The study was designed as prospective, randomized, single blind. Inclusion criteria were severe exacerbation of COPD (worsening of dyspnea, FEV1 at admission < 1 L or < 35 %pred. ; SpO2 < 92 %; respiratory rate > 24 min–1 ); age > 45 yrs; smoking history > 10 packs/yrs; no need for invasive respiratory support. Fifty patients with COPD (M: F = 41: 9; mean age, 68 yrs; mean FEV1 , 0.72 L, mean PaO2, 46 mm Hg) were included in the study and randomized to receive either nebilized salbutamol 2.5 mg and ipratropium bromide 500 mg q4h for 7 days (n = 26) or nebilized salbutamol 2.5 mg alone q4h for 7 days (n = 24). All patients also received oral corticosteroids, antibiotics, oxygen and nonin vasive ventilation if necessary. There were no differences between the groups in demographic, functional or gasometric parameters. Both groups showed significant improvements in FEV1, FVC and IC, but treatment with combined therapy rather than salbutamol alone resulted in more rapid improvement in FVC (in 1 day: 1.90 ± 0.51 L vs 1.61 ± 0.50 L, р = 0.048; in 3 days: 2.00 ± 0.51 L vs 1.67 ± 0.49 L, р = 0.024) and in IC (in 1 day: 1.67 ± 0.39 L vs 1.38 ± 0.37 L, р = 0.010; in 3 days: 21.77 ± 0.51 L vs 1.44 ± 0.40 L, р = 0.015). Dyspnea (Visual Analog Score) also improved more rapidly in patients received salbutamol and ipratropium (in 1 day: 32 ± 13 mm vs 42 ± 15 mm, р = 0.019; in 3 days: 26 ± 11 mm vs 33 ± 13 mm, р = 0.045). The need for additional salbutamol inhalations was significantly higher in patients received salbutamol alone (5.6 ± 3.5 vs 1.3 ± 1.5 inhalations per 1 patient during 7 days, p < 0.01). There was no difference between two groups with regards to other parameters including respiratory rate, pulse, PaCO2 , pH, and other parameters excepting more marked increase in the PaO2 in the 1st group after 1 day of the therapy (р = 0.019). The incidence of adverse events was similar in both the groups. Therefore, in severe exacerbations of COPD, the combined therapy with nebulized salbutamol and ipratropium is more effective than nebulized salbutamol alone.

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The authors declare that there are no conflicts of interest present.