目的 探討乙酰半胱氨酸溶液聯(lián)合特布他林治療慢性阻塞性肺疾病急性加重期（AECOPD）的臨床效果。方法 選取2018年2月—2020年2月天津市第五中心醫(yī)院（北京大學(xué)濱海醫(yī)院）急診留觀病房收治的106例AECOPD患者，根據(jù)隨機(jī)數(shù)字表法將其分為對(duì)照組（n=53）和治療組（n=53）。對(duì)照組給予硫酸特布他林氣霧劑吸入治療，0.5 mg/次，3次/d。治療組在對(duì)照組基礎(chǔ)上給予吸入用乙酰半胱氨酸溶液霧化吸入，3 mL/次，2次/d。所有患者均連續(xù)治療14 d。觀察兩組臨床療效及典型表現(xiàn)的緩解時(shí)間，比較治療前后兩組咳嗽和咳痰的評(píng)估問(wèn)卷（CASA-Q）總分、慢性阻塞性肺疾病患者自我評(píng)估測(cè)試（CAT）問(wèn)卷評(píng)分、第1秒用力呼氣容積（FEV₁）與用力肺活量比值（FEV₁/FVC）、FEV₁占預(yù)計(jì)值、最大自主通氣量（MVV）、深吸氣量（IC）及血清和肽素（copeptin）、總抗氧化能力（TAC）、谷胱甘肽過(guò)氧化物酶（GSH-Px）、8-羥基脫氧鳥(niǎo)苷（8-OHdG）、內(nèi)皮素-1（ET-1）水平。結(jié)果 治療后，治療組患者總有效率是94.3%，較對(duì)照組81.1%顯著提高（P<0.05）。治療組各項(xiàng)典型表現(xiàn)（喘息、咳痰、咳嗽、肺部哮鳴音）的緩解時(shí)間均顯著短于對(duì)照組（P<0.05）。治療后，兩組CASA-Q總分均顯著增加，CAT問(wèn)卷評(píng)分則顯著降低（P<0.05）；且治療后，治療組CASA-Q總分、CAT問(wèn)卷評(píng)分改善優(yōu)于對(duì)照組（P<0.05）。治療后，兩組FEV₁/FVC、FEV₁占預(yù)計(jì)值、MVV、IC值均較本組治療前顯著提高（P<0.05）；且治療后，治療組肺功能參數(shù)值的提高作用較同期對(duì)照組更顯著（P<0.05）。治療后，兩組血清copeptin、8-OHdG及ET-1水平均較本組治療前顯著下降，但血清TAC、GSH-Px水平則均顯著上升（P<0.05）；治療后，治療組血清學(xué)指標(biāo)改善優(yōu)于對(duì)照組（P<0.05）。結(jié)論 乙酰半胱氨酸溶液聯(lián)合特布他林治療AECOPD總體療效確切，能安全有效且迅速地緩解患者呼吸道癥狀，改善患者肺功能及生活質(zhì)量，可能與機(jī)體炎癥及氧化應(yīng)激反應(yīng)的顯著減輕有關(guān)。

Objective To investigate the clinical effect of acetylcysteine solution combined with terbutaline in treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 106 AECOPD patients admitted to the emergency observation ward of Tianjin Fifth Central Hospital (Peking University Binhai Hospital) from February 2018 to February 2020 were selected and divided into control group (n=53) and treatment group (n=53) according to random number table method. The control group was treated with Terbutaline Sulfate Aerosol, 0.5 mg/time, 3 times daily. The treatment group was given Acetylcysteine Solution for Inhalation on the basis of the control group, 3 mL (1 ampoule)/time, twice daily. All patients were treated for 14 d. The clinical efficacy and remission time of typical symptoms of the two groups were observed. The total score of cough and sputum assessment Questionnaire (CASA-Q), the score of CAT questionnaire for patients with chronic obstructive pulmonary disease, the ratio of forced expiratory volume (FEV₁) to forced pulmonary capacity (FEV₁/FVC), the percentage of FEV₁ in the estimated value%, the maximum spontaneous ventilation (MVV) and deep inspiratory volume (IC) were compared between the two groups before and aftertreatment. The levels of serum copeptin, total antioxidant capacity (TAC), glutathione peroxidase (GSH-Px), 8-hydroxy-deoxyguanosine (8-OHdG) and endothelin-1 (ET-1) were determined. Results After treatment, the total effective rate in the treatment group was 94.3%, significantly higher than that in the control group (81.1%) (P < 0.05). The relief time of typical symptoms (wheezing, expectoration, cough and pulmonary wheezing) in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, CASA-Q scores in both groups were significantly increased, while CAT questionnaire scores were significantly decreased (P < 0.05). After treatment, CASA-Q total score and CAT questionnaire score in the treatment group were improved better than those in the control group (P < 0.05). After treatment, FEV₁/FVC, FEV₁%, MVV and IC values in two groups were significantly increased compared with those before treatment (P < 0.05); After treatment, the improvement of lung function parameters in the treatment group was more significant than that in the control group (P < 0.05). After treatment, the levels of serum Copeptin, 8-OHdG and ET-1 in two groups were significantly decreased compared with before treatment, but the levels of serum TAC and GSH-Px were significantly increased (P < 0.05). After treatment, serological indexes in the treatment group were better than those in the control group (P < 0.05). Conclusion Acetylcysteine solution combined with terbutaline has overall definite effect in treatment of acute exacerbation of chronic obstructive pulmonary disease, and can safely, effectively and rapidly relieve the respiratory symptoms of patients, improve the lung function and life quality of the patients, which may be significantly related to inflammation and oxidative stress.

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