目的 观察布地奈德联合氨溴索雾化吸入治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床疗效。方法 选取2012年2月—2013年10月上海市浦东新区康桥社区卫生服务中心收治的AECOPD患者125例，随机分为治疗组（59例）和对照组（66例）。所有患者均给予常规的控制感染、吸氧、解痉、平喘等治疗。治疗组在常规治疗的基础上给予雾化吸入布地奈德混悬液2 mg/次和盐酸氨溴索注射液30 mg/次，10～15 min/次，2次/d。对照组给予雾化吸入布地奈德混悬液2 mg/次和注射用糜蛋白酶4×10³ U/次，10～15 min/次，2次/d。两组均持续治疗7 d。治疗后，对两组的临床疗效进行评价，同时对其肺功能和血气分析指标进行检测。结果 治疗组和对照组的总有效率分别为93.2%、78.8%，两组比较差异有统计学意义（P<0.05）。治疗组喘鸣消失时间、咳嗽缓解时间、湿音消失时间和住院时间均显著短于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者血气分析（PaCO₂、PaO₂）和肺功能（FEV₁、FEV₁/FVC）指标均显著改善，同组治疗前后差异有统计学意义（P<0.05）；治疗后治疗组这些观察指标改善程度优于对照组，两组比较差异有统计学意义（P<0.05）。结论 布地奈德联合氨溴索雾化吸入治疗AECOPD具有较好的临床疗效，并能显著改善患者血气分析和肺功能指标，值得临床推广。

Objective To investigate the clinical efficacy of budesonide combined with ambroxol aerosol inhalation in treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Patients with AECOPD (125 cases) in Kangqiao Community Health Service Center of Pudong New District in Shanghai from February 2012 to October 2013 were randomly divided into treatment (n = 59) and control (n = 66) groups. All patients were given routine treatment such as infection control, oxygen, spasmolysis, and smooth wheezing. The patients in the treatment group were accepted aerosol inhalation with Budesonide Mixed Suspension (2 mg/time) and Ambroxol Hydrochloride Injection (30 mg/time) on the basis of routine therapy, 10 — 15 min/time, twice daily. The patients in the control group accepted aerosol inhalation with Budesonide Mixed Suspension (2 mg/time) and Chymotrypsin for injection (4×10³ U/time), 10 — 15 min/time, twice daily. The patients in the two groups were treated continuously for 7 d. After treatment, the treatment efficacy was evaluated, while lung function and blood gas analysis indexes were tested.Results The total effective rates of the treatment and control groups were 93.2% and 78.8%, respectively, with significant difference between two groups (P < 0.05). The time periods of wheezing disappearing, cough easing, wet sound disappearing, and hospital stay in treatment group were significantly shorter than those in the control group, with significant difference between two groups (P < 0.05). After treatment, blood gas analysis indexes (PaCO₂ and PaO₂) and pulmonary function indexes (FEV₁ and FEV₁/FVC) were significantly improved, with statistically significant difference before and after treatment (P < 0.05). Those detection indexes in the treatment group were improved better than those in the control group, with statistically significant difference (P < 0.05). Conclusion Budesonide combined with ambroxol aerosol inhalation has a good clinical efficacy in treatment of AECOPD, and can significantly improve blood gas analysis and lung function indexes, which is worthy of clinical application.

浦东新区卫生系统优秀青年医学人才培养计划资助项目（PWRq2011-34）