目的 探討茚達(dá)特羅格隆溴銨聯(lián)合羧甲司坦治療老年慢性阻塞性肺疾病的臨床療效。方法 選取2018年10月—2020年10月在上海中醫(yī)藥大學(xué)附屬曙光醫(yī)院治療的182例老年慢性阻塞性肺疾病患者，根據(jù)隨機(jī)數(shù)字表法分為對照組（91例）和治療組（91例）。對照組患者口服羧甲司坦片，2片/次，3次/d。治療組患者在對照組的基礎(chǔ)上吸入茚達(dá)特羅格隆溴銨吸入粉霧劑，1粒/次，1次/d。兩組患者治療10 d。觀察兩組患者臨床療效，比較治療前后兩組患者臨床癥狀緩解時間、動脈血?dú)?、肺功能，血清炎性因子白?xì)胞介素-18（IL-18）、白細(xì)胞介素-32（IL-32）、腫瘤壞死因子-α（TNF-α）和高遷移率蛋白（HMGB1）水平及不良反應(yīng)情況。結(jié)果 治療后，治療組患者總有效率明顯高于對照組（98.91%vs 87.91%，P<0.05）。治療后，治療組癥狀好轉(zhuǎn)時間明顯短于對照組（P<0.05）。治療后，兩組動脈血氧分壓（pO₂）、第1秒用力呼氣容積（FEV₁）、第1秒用力呼氣容積占用力肺活量的比值（FEV₁/FVC）均明顯高于對照組，而二氧化碳分壓（pCO₂）明顯低于同組治療前（P<0.05）；治療后，治療組動脈血?dú)?、肺功能指?biāo)改善優(yōu)于對照組（P<0.05）。治療后，兩組IL-18、IL-32、TNF-α、HMGB1水平均明顯降低（P<0.05），且治療后治療組降低更明顯（P<0.05）。治療組不良反應(yīng)發(fā)生率明顯低于對照組（4.39%vs 10.99%，P<0.05）。結(jié)論 羧甲司坦聯(lián)合茚達(dá)特羅格隆溴銨治療老年慢性阻塞性肺疾病效果顯著，臨床癥狀緩解較快，能有效改善動脈血氧及肺功能狀態(tài)，降低炎性反應(yīng)，不良反應(yīng)較小。

Objective To explore the clinical study of indacaterol combined with carbocysteine in treatment of chronic obstructive pulmonary disease in the elderly. Methods Elderly patients (182 cases) with chronic obstructive pulmonary disease in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October 2018 to October 2020 were randomly divided into control (91 cases) and treatment (91 cases) group. Patients in the control group were po administered with Carbocysteine Tablets, 2 tablets/time, three times daily. Patients in the treatment group were po administered with Indacaterol Maleate and Glycopyrronium Bromide Powder for inhalation, 1 grain/time, once daily. Patients in two groups were treated for 10 d. After treatment, the clinical evaluation was evaluated, the improvement time of clinical symptoms, the arterial blood gas, the lung function, the levels of serum inflammatory factor IL-18, IL-32, TNF-α, and HMGB1, adverse drug reactions in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was significantly higher than that of the control group (98.91% vs 87.91%, P < 0.05). After treatment, the time of symptom improvement in the treatment group was significantly earlier than that in the control group (P < 0.05). After treatment, pO₂, FEV₁ and FEV₁/FVC in two groups were significantly higher than those in control group, while pCO₂ was significantly lower than that before treatment (P < 0.05). After treatment, the improvement of arterial blood gas and lung function indexes in the treatment group was better than that in the control group (P < 0.05). After treatment, the levels of IL-18, IL-32, TNF-α and HMGB1 in two groups were significantly decreased (P < 0.05), and the decrease was more obvious in the treatment group (P < 0.05). The incidence of adverse reactions in treatment group was significantly lower than that in the control group (4.39% vs 10.99%, P < 0.05). Conclusion The effect of indacaterol combined with carbocysteine in treatment of chronic obstructive pulmonary disease in the elderly is remarkable, the clinical symptoms are relieved quickly, the combination can effectively improve the arterial oxygen and pulmonary function, reduce the inflammatory reaction, and the adverse reaction is less.

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