- 期刊
Effects of Combined Long-Acting Beta 2-Agonists and Inhaled Corticosteroids Therapy on Lung Mechanics and Airway Secretion in Prolonged Mechanical Ventilation Patients with Chronic Obstructive Pulmonary Disease
評估使用長效乙二型擴張劑（LABA）及吸入性類固醇（ICS）合併吸入劑對於長期呼吸器依賴的慢性阻塞性肺病患者在肺部機械力學及痰液量的影響
摘要
前言：評估使用長效乙二型擴張劑（LABA）及吸入性類固醇（ICS）合併吸入劑對於長期呼吸器依賴的慢性阻塞性肺病患者在肺部機械力學及痰液量的影響。方法：我們回溯性的從2011年10月01日至2011年12月31日期間，針對於台中榮民總醫院嘉義分院呼吸照護病房長期呼吸器依賴的慢性阻塞性肺病患者，接受長效乙二型擴張劑（LABA）及吸入性類固醇（ICS）合併吸入劑的案例做病歷資料回顧。我們收集並記錄個案相關的流行病學情形，營養參數及呼吸道動力參數。收案個案給予每天兩次、每次四噴的長效乙二型擴張劑（LABA）及吸入性類固醇（ICS）合併吸入劑，為期六週的藥物使用。收案期間，每週都會定期分析相關指標及參數（痰液分泌量化指數、呼吸道阻力指數、肺炎發生率及呼吸器脫離情形）。結果：經篩選後符合收案條件的共19位男性病患。平均年齡為81.1±7.6歲，使用呼吸器的平均時間為198.7±254.9天。每天維持足夠的灌食熱量（1821.0±199.0大卡路里），檢測其營養狀況皆呈現慢性耗損情形：低白蛋白（albumin: 2.9±0.5 g/dL）及低身體質量指數（BMI: 19.8±3.8）。病患大多呈現氣道痰液清除能力較差且合併較高的呼吸道阻力。經由使用長效乙二型擴張劑（LABA）及吸入性類固醇（ICS）合併吸入劑後發現呼吸道阻力可下降達16.3±15.2%，痰液分泌量化指數也明顯改善，呼吸器相關肺炎（VAP）發生次數從每月0.82±0.75次減為0.56±0.55次。最後有3位病患成功脫離呼吸器（平均脫離率為18.5%）。結論：從我們的研究觀察發現，使用長效乙二型擴張劑（LABA）及吸入性類固醇（ICS）合併吸入劑對於長期呼吸器依賴的慢性阻塞性肺病患者可以降低呼吸道阻力，減少痰液分泌量及有較低呼吸器相關肺炎（VAP）發生的機會，關於協助脫離呼吸器，需要更多大型的研究來進一步佐證。
並列摘要
Background: To investigate the effect of combined long-acting β2 agonists (LABA)/ inhaled corticosteroids (ICS) on the lung mechanics and airway secretion in prolonged mechanical ventilation (PMV) patients with chronic obstructive pulmonary disease (COPD). Methods: Data from PMV patients receiving LABA/ICS in the respiratory care ward of Taichung Veterans General Hospital-Chiayi Branch from October 1 to December 31, 2011 were reviewed. The demographic data, nutrient parameters, and airway dynamic parameters were recorded. The weekly checked data during the 6-week period of use of LABA/LCS (4 puffs twice a day) were analyzed, including secretion quantitative grading scores, airway resistance, incidence of pneumonia, and weaning status. Results: Nineteen male patients with a mean age of 81.1±7.6 years and duration of ventilator use of 198.7±254.9 days were enrolled. They were in a chronic wasting status with low albumin (2.8±0.5 g/dL) and body mass index (19.8±3.8) despite adequate caloric intake (1821.0±199.0 kcal). Airway secretion clearance and dynamic parameters showed impaired airway secretion clearance and increased airway resistance. After the use of LABA/ ICS, airway resistance decreased by 16.3±15.2% temporally. Airway secretion quantitative scores decreased gradually and the frequency of ventilator-associated pneumonia (VAP) also significantly decreased from 0.82±0.75 to 0.56±0.55 times/month. Three patients were weaned from ventilator support for a cumulative weaning rate of 18.5%. Conclusions: A reduction of airway resistance, airway secretion, and incidence of VAP and ventilator-dependent conditions with combined use of LABA/ICS in PMV patients with COPD was observed. However, more prospective studies are needed to validate further utilization of LABA/ICS for those patients weaning from ventilation.