目的 探讨慢性阻塞性肺气肿患者采用咳喘顺丸联合吸入用异丙托溴铵治疗的临床疗效。方法 选取2018年12月—2019年12月于中国平煤神马集团职业病防治院就诊的慢性阻塞性肺气肿患者124例作为研究对象，根据入组顺序将患者分成对照组和治疗组，每组各62例。对照组患者给予吸入用异丙托溴铵溶液，500 μg/次，3次/d；治疗组患者在对照组用药基础上口服咳喘顺丸，5 g/次，3次/d。两组患者均连续治疗2周。观察两组的临床疗效，比较两组肺功能指标、外周血清指标、圣乔治问卷（SGRQ）评分、6 min步行距离。结果 治疗后，治疗组患者临床总有效率要显著高于对照组患者（95.16%vs 80.65%），两组比较差异有统计学意义（P<0.05）。治疗后，两组患者肺功能指标用力肺活量（FVC）、呼气高峰流量（PEFR）和第1秒用力肺活量/FVC（FEV₁/FVC）均较治疗前显著升高（P<0.05），且治疗后治疗组肺功能指标较对照组升高的更为显著（P<0.05）。两组患者外周血肿瘤坏死因子α（TNF-α）、periostin及血小板衍生生长因子B（PDGF-B）水平均较治疗前显著降低（P<0.05）；且治疗组各指标较对照组降低的更为显著，组间比较均具有显著性差异（P<0.05）。治疗后，两组SGRQ评分显著降低，但6 min步行距离均较治疗前显著增加（P<0.05）；且治疗后治疗组SGRQ评分显著低于对照组，而6 min步行距离高于对照组（P<0.05）。结论 咳喘顺丸联合吸入用异丙托溴铵治疗慢性阻塞性肺气肿疗效显著、安全性高，且能够显著改善患者肺功能与生活质量，促进外周血清学指标的转归，具有一定的临床推广应用价值。

Objective To explore the clinical efficacy of Kechuanshun Pills combined with ipratropium bromide in treatment of chronic obstructive emphysema. Methods 124 Patients with chronic obstructive emphysema in China Pingmei Shenma Group Occupational Disease Prevention Hospital from December 2018 to December 2019 were selected as the research objects. The patients were divided into control group and treatment group according to the order of inclusion, with 62 patients in each group. Patients in the control group were given Ipratropium Bromide Solution for inhalation, 500 μg/time, 3 times daily. Patients in the treatment group were po administered with Kechuanshun Pills on the basis of medication in the control group, 5 g/time, 3 times daily. Patients in both groups were treated continuously for 2 weeks. The clinical efficacy of the two groups was observed, and lung function indexes, peripheral blood serum indexes, SGRQ scores and 6min walking distance were compared between the two groups. Results After treatment, the total clinical efficiency of patients in the treatment group was significantly higher than that in the control group (95.16% vs 80.65%), and the difference between the two groups was statistically significant (P<0.05). After treatment, FVC, PEFR and FEV₁/FVC in both groups were significantly increased compared with those before treatment (P<0.05), and the pulmonary function indexes in the treatment group were significantly increased compared with those in the control group (P<0.05). The peripheral blood levels of TNF-α, periostin and PDGF-B in both groups were significantly lower than those before treatment (P<0.05). In addition, compared with the control group, the reduction of each indicator in the treatment group was more significant, and there were significant differences between groups (P<0.05). After treatment, SGRQ scores of the two groups were significantly decreased, but the walking distance of 6 min was significantly increased compared with that before treatment (P<0.05). After treatment, SGRQ score of the treatment group was significantly lower than that of the control group, and the walking distance of 6 min was higher than that of the control group (P<0.05). Conclusion Kechuanshun Pills combined with ipratropium bromide has significant curative effect and high safety in treatment of chronic obstructive emphysema, and can significantly improve the pulmonary function and life quality of patients, and promote the outcome of peripheral blood serum indicators, which has certain clinical application value.

R974

河南省医学科技攻关计划项目（201501007）