目的 探討左沙丁胺醇和沙丁胺醇分別聯(lián)合異丙托溴銨和倍氯米松用于急性加重期慢性阻塞性肺疾?。ˋECOPD）患者的安全性、有效性差異。方法 采用隨機對照、單中心、前瞻性研究方法，選取2022年1月1日—2022年12月31日在合肥市第二人民醫(yī)院呼吸內(nèi)科就診的100例AECOPD住院患者作為研究對象，利用PASS 26.0軟件隨機分為對照組（n=50）和試驗組（n=50）。對照組使用沙丁胺醇、異丙托溴銨和倍氯米松霧化吸入治療，試驗組使用左沙丁胺醇、異丙托溴銨和倍氯米松霧化吸入治療，比較兩組患者治療前后臨床相關(guān)指標變化以及不良反應(yīng)發(fā)生情況。結(jié)果 試驗組治療總有效率（95.65%）高于對照組（84.00%），差異有統(tǒng)計學意義（P＜0.05）。治療前兩組24 h痰液體積、血氣分析指標［動脈血氧分壓（paO₂）、動脈血二氧化碳分壓（paCO₂）、動脈血氧飽和度（SaO₂）］、肺功能指標［第1秒呼氣量（FEV₁）、用力肺活量（FVC）、1秒率（FEV₁/FVC）］、血清炎癥因子指標［超敏C反應(yīng)蛋白（hs-CRP）、白細胞介素-8（IL-8）、腫瘤壞死因子-α（TNF-α）］、氧化應(yīng)激反應(yīng)指標［丙二醛（MDA）、谷胱甘肽過氧化物酶（GSH-Px）、超氧化物歧化酶（SOD）］比較，差異無統(tǒng)計學意義（P＞0.05）；治療后，兩組24 h痰液體積、pa（CO₂）、慢阻肺急性加重識別工具（CERT）評分、MDA、hs-CRP、IL-8、TNF-α均較本組治療前下降，pa（O₂）、FEV₁、FVC、FEV₁/FVC、GSH-Px、SOD較本組治療前顯著升高，差異均有統(tǒng)計學意義（P＜0.05）。治療后，試驗組各項指標改善情況均較對照組明顯（P＜0.05）。在治療過程中，對照組耐受良好，未出現(xiàn)明顯不良反應(yīng)。試驗組發(fā)生頭痛2例、皮疹和腹瀉各1例，兩組不良反應(yīng)發(fā)生率相比較，差異有統(tǒng)計學差異（P＜0.05）。結(jié)論 加入左沙丁胺醇的三聯(lián)藥物方案用于治療AECOPD患者的臨床療效比沙丁胺醇三聯(lián)方案更好，但不良反應(yīng)發(fā)生率更高，臨床應(yīng)用需關(guān)注其安全性。

Objective To explore the differences in safety and efficacy between levosalbutamol and salbutamol in combination with ipratropium bromide and beclomethasone for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A randomized controlled, single center, prospective study method was used to select 100 hospitalized AECOPD patients who visited the Department of Respiratory Medicine of the Second People's Hospital of Hefei from January 1, 2022 to December 31, 2022 as the study subjects. PASS 26.0 software was used to randomly divide them into a control group (n=50) and an experimental group (n =50). Patients in the control group were treated with nebulized inhalation of salbutamol, ipratropium bromide, and beclomethasone, while patients in the experimental group were treated with nebulized inhalation of levosalbutamol, ipratropium bromide, and beclomethasone. The changes in clinical indicators and incidence of adverse reactions before and after treatment were compared between the two groups of patients. Results The total effective rate of the experimental group (95.65%) was higher than that of the control group (84.00%), and the difference was statistically significant (P＜0.05). 24 hour sputum volume, blood gas analysis indicators [arterial oxygen partial pressure (paO₂), arterial carbon dioxide partial pressure (paCO₂), arterial oxygen saturation (SaO₂)], lung function indicators (FEV₁, FVC, FEV₁/FVC), serum inflammatory factor indicators (hs-CRP, IL-8, TNF-α) in the two groups before treatment. The comparison of oxidative stress response indicators (MDA, GSH-Px, SOD) showed no statistically significant difference (P＞0.05). After treatment, the 24-hour sputum volume, paCO₂, chronic obstructive pulmonary disease acute exacerbation recognition tool (CERT) score, MDA, hs-CRP, IL-8, TNF-α in both groups. All decreased compared to before treatment in same group, while paO₂, FEV₁, FVC, FEV₁/FVC, GSH-Px, SOD significantly increased compared to before treatment in same group, and the differences were statistically significant (P＜0.05). After treatment, the improvement of various indicators in the experimental group was significantly higher than that in the control group (P＜0.05). During the treatment process, the control group tolerated well and did not experience any significant adverse reactions. There were two cases of headache, one case of rash, and one case of diarrhea in the experimental group. The incidence of adverse reactions between the two groups was statistically different (P＜0.05). Conclusion The clinical efficacy of the triple drug regimen with the addition of levosalbutamol in the treatment of AECOPD patients is better than that of the triple drug regimen with salbutamol, but the incidence of adverse reactions is higher. Clinical application needs to pay attention to its safety.

R974

國家自然科學基金青年基金項目（82003849）；合肥市衛(wèi)生健康應(yīng)用醫(yī)學研究項目（Hwk2021yb010）；安徽省教育廳省級質(zhì)量工程項目（2019xqsxzx98）；合肥市第二人民醫(yī)院院級科研項目（1604a0802099）