目的 探究沙美特羅替卡松粉吸入劑聯(lián)合噻托溴銨吸入劑在慢性阻塞性肺疾病（COPD）急性加重期治療中的應(yīng)用價值。方法 將240例在河南省人民醫(yī)院呼吸與危重癥醫(yī)學(xué)科治療的COPD急性加重期患者作為研究對象，隨機(jī)分成對照組和觀察組，對照組采用以噻托溴銨吸入劑為主的基礎(chǔ)治療，觀察組采用噻托溴銨吸入劑聯(lián)合沙美特羅替卡松粉吸入劑治療，比較兩組人員的治療效果、肺功能指標(biāo)以及炎癥因子水平。結(jié)果 與治療前比較，治療14 d后，對照組與觀察組的用力肺活量（FVC）、第1秒用力呼氣量（FEV1）、最大呼氣流量（PEF）、第1秒用力呼氣量占預(yù)計值的百分比（FEV1%）及每分鐘最大通氣量（MVV）均顯著升高，且觀察組顯著高于對照組（P<0.05）。與治療前比較，治療后對照組、觀察組氧分壓（PaO₂）、氧飽和度（SaO₂）均顯著升高，而二氧化碳分壓（PaCO₂）均顯著下降（P<0.05）；治療14 d后，觀察組SaO₂和PaO₂顯著高于對照組，而PaCO₂顯著低于對照組（P<0.05）。治療14 d后，對照組與觀察組的氣管壁厚度（WT）、器官壁總面積（WA）、管壁厚度/外徑（T/D）均顯著降低，官腔面積（AI）水平顯著升高，且觀察組均顯著優(yōu)于對照組（P<0.05）。對照組與觀察組的血清降鈣素原（PCT）、白細(xì)胞介素-6（IL-6）、C反應(yīng)蛋白（CRP）水平均顯著降低，可溶性腫瘤壞死因子受體（sT-NFR）水平顯著升高，且觀察組顯著優(yōu)于對照組（P<0.05）。對照組與觀察組的圣喬治呼吸問卷（SGRQ）評分均顯著降低，且觀察組顯著低于對照組（P<0.05）。結(jié)論 噻托溴銨聯(lián)合沙美特羅替卡松能夠明顯改善COPD急性加重期患者的肺功能、減輕炎癥反應(yīng)、提高生活質(zhì)量。

Objective To explore the value of tiotropium joint salmeterol fluticasone for Inhalation in the treatment of acute exacerbation of COPD. Methods 240 patients with acute exacerbation of COPD treated in Henan People's Hospital were randomly divided into A group and B group. Group A received basic treatment mainly with tiotropium bromide inhalation, while B group was treated with tiotropium joint salmeterol fluticasone for Inhalation. The therapeutic effects, pulmonary function and inflammatory factors were compared between the two groups. Results After 14 days of treatment, FVC, FEV1, PEF, FEV1% and MVV of the observation and control group were significantly higher than before treatment, and the index of control group were significantly higher than observation group (P<0.05). After 14 days of treatment, PaO₂ and SaO₂ of the observation and control group were significantly higher than before treatment, PaCO₂ was significantly lower, and the index of control group were significantly higher than observation group (P<0.05). After 14 days of treatment, the thickness of trachea wall (WT), the total area of organ wall (WA) and the thickness/outer diameter of tube wall (T/D) of the observation and control group were significantly lower than before treatment, and the index of control group were significantly higher than observation group (P<0.05), the level of lumen area (AI) in the observation group was significantly higher than that in the control group (P<0.05). The levels of procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP) in the control and observation group were lower than those before treatment, and the levels of soluble tumor necrosis factor receptor (st NFR) were higher than those before treatment, the index in observation group was better than control group (P<0.05). The SGRQ score of the control and observation group was lower than than those before treatment, SGRQ score of observation group was lower than that of control group, the difference was significant (P<0.05). Conclusion Tiotropium bromide combined with salmeterol/fluticasone can obviously improve the lung function, relieve the inflammatory response and the quality of life in the patients with acute exacerbation of COPD, and it has a good effect.

R969;R974