目的 探討慢性阻塞性肺氣腫患者采用咳喘順丸聯(lián)合吸入用異丙托溴銨治療的臨床療效。方法 選取2018年12月—2019年12月于中國平煤神馬集團職業(yè)病防治院就診的慢性阻塞性肺氣腫患者124例作為研究對象，根據(jù)入組順序?qū)⒒颊叻殖蓪φ战M和治療組，每組各62例。對照組患者給予吸入用異丙托溴銨溶液，500 μg/次，3次/d；治療組患者在對照組用藥基礎(chǔ)上口服咳喘順丸，5 g/次，3次/d。兩組患者均連續(xù)治療2周。觀察兩組的臨床療效，比較兩組肺功能指標、外周血清指標、圣喬治問卷（SGRQ）評分、6 min步行距離。結(jié)果 治療后，治療組患者臨床總有效率要顯著高于對照組患者（95.16%vs 80.65%），兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組患者肺功能指標用力肺活量（FVC）、呼氣高峰流量（PEFR）和第1秒用力肺活量/FVC（FEV₁/FVC）均較治療前顯著升高（P<0.05），且治療后治療組肺功能指標較對照組升高的更為顯著（P<0.05）。兩組患者外周血腫瘤壞死因子α（TNF-α）、periostin及血小板衍生生長因子B（PDGF-B）水平均較治療前顯著降低（P<0.05）；且治療組各指標較對照組降低的更為顯著，組間比較均具有顯著性差異（P<0.05）。治療后，兩組SGRQ評分顯著降低，但6 min步行距離均較治療前顯著增加（P<0.05）；且治療后治療組SGRQ評分顯著低于對照組，而6 min步行距離高于對照組（P<0.05）。結(jié)論 咳喘順丸聯(lián)合吸入用異丙托溴銨治療慢性阻塞性肺氣腫療效顯著、安全性高，且能夠顯著改善患者肺功能與生活質(zhì)量，促進外周血清學(xué)指標的轉(zhuǎn)歸，具有一定的臨床推廣應(yīng)用價值。

Objective To explore the clinical efficacy of Kechuanshun Pills combined with ipratropium bromide in treatment of chronic obstructive emphysema. Methods 124 Patients with chronic obstructive emphysema in China Pingmei Shenma Group Occupational Disease Prevention Hospital from December 2018 to December 2019 were selected as the research objects. The patients were divided into control group and treatment group according to the order of inclusion, with 62 patients in each group. Patients in the control group were given Ipratropium Bromide Solution for inhalation, 500 μg/time, 3 times daily. Patients in the treatment group were po administered with Kechuanshun Pills on the basis of medication in the control group, 5 g/time, 3 times daily. Patients in both groups were treated continuously for 2 weeks. The clinical efficacy of the two groups was observed, and lung function indexes, peripheral blood serum indexes, SGRQ scores and 6min walking distance were compared between the two groups. Results After treatment, the total clinical efficiency of patients in the treatment group was significantly higher than that in the control group (95.16% vs 80.65%), and the difference between the two groups was statistically significant (P<0.05). After treatment, FVC, PEFR and FEV₁/FVC in both groups were significantly increased compared with those before treatment (P<0.05), and the pulmonary function indexes in the treatment group were significantly increased compared with those in the control group (P<0.05). The peripheral blood levels of TNF-α, periostin and PDGF-B in both groups were significantly lower than those before treatment (P<0.05). In addition, compared with the control group, the reduction of each indicator in the treatment group was more significant, and there were significant differences between groups (P<0.05). After treatment, SGRQ scores of the two groups were significantly decreased, but the walking distance of 6 min was significantly increased compared with that before treatment (P<0.05). After treatment, SGRQ score of the treatment group was significantly lower than that of the control group, and the walking distance of 6 min was higher than that of the control group (P<0.05). Conclusion Kechuanshun Pills combined with ipratropium bromide has significant curative effect and high safety in treatment of chronic obstructive emphysema, and can significantly improve the pulmonary function and life quality of patients, and promote the outcome of peripheral blood serum indicators, which has certain clinical application value.

R974

河南省醫(yī)學(xué)科技攻關(guān)計劃項目（201501007）