目的 探讨茚达特罗格隆溴铵联合羧甲司坦治疗老年慢性阻塞性肺疾病的临床疗效。方法 选取2018年10月—2020年10月在上海中医药大学附属曙光医院治疗的182例老年慢性阻塞性肺疾病患者，根据随机数字表法分为对照组（91例）和治疗组（91例）。对照组患者口服羧甲司坦片，2片/次，3次/d。治疗组患者在对照组的基础上吸入茚达特罗格隆溴铵吸入粉雾剂，1粒/次，1次/d。两组患者治疗10 d。观察两组患者临床疗效，比较治疗前后两组患者临床症状缓解时间、动脉血气、肺功能，血清炎性因子白细胞介素-18（IL-18）、白细胞介素-32（IL-32）、肿瘤坏死因子-α（TNF-α）和高迁移率蛋白（HMGB1）水平及不良反应情况。结果 治疗后，治疗组患者总有效率明显高于对照组（98.91%vs 87.91%，P<0.05）。治疗后，治疗组症状好转时间明显短于对照组（P<0.05）。治疗后，两组动脉血氧分压（pO₂）、第1秒用力呼气容积（FEV₁）、第1秒用力呼气容积占用力肺活量的比值（FEV₁/FVC）均明显高于对照组，而二氧化碳分压（pCO₂）明显低于同组治疗前（P<0.05）；治疗后，治疗组动脉血气、肺功能指标改善优于对照组（P<0.05）。治疗后，两组IL-18、IL-32、TNF-α、HMGB1水平均明显降低（P<0.05），且治疗后治疗组降低更明显（P<0.05）。治疗组不良反应发生率明显低于对照组（4.39%vs 10.99%，P<0.05）。结论 羧甲司坦联合茚达特罗格隆溴铵治疗老年慢性阻塞性肺疾病效果显著，临床症状缓解较快，能有效改善动脉血氧及肺功能状态，降低炎性反应，不良反应较小。

Objective To explore the clinical study of indacaterol combined with carbocysteine in treatment of chronic obstructive pulmonary disease in the elderly. Methods Elderly patients (182 cases) with chronic obstructive pulmonary disease in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October 2018 to October 2020 were randomly divided into control (91 cases) and treatment (91 cases) group. Patients in the control group were po administered with Carbocysteine Tablets, 2 tablets/time, three times daily. Patients in the treatment group were po administered with Indacaterol Maleate and Glycopyrronium Bromide Powder for inhalation, 1 grain/time, once daily. Patients in two groups were treated for 10 d. After treatment, the clinical evaluation was evaluated, the improvement time of clinical symptoms, the arterial blood gas, the lung function, the levels of serum inflammatory factor IL-18, IL-32, TNF-α, and HMGB1, adverse drug reactions in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was significantly higher than that of the control group (98.91% vs 87.91%, P < 0.05). After treatment, the time of symptom improvement in the treatment group was significantly earlier than that in the control group (P < 0.05). After treatment, pO₂, FEV₁ and FEV₁/FVC in two groups were significantly higher than those in control group, while pCO₂ was significantly lower than that before treatment (P < 0.05). After treatment, the improvement of arterial blood gas and lung function indexes in the treatment group was better than that in the control group (P < 0.05). After treatment, the levels of IL-18, IL-32, TNF-α and HMGB1 in two groups were significantly decreased (P < 0.05), and the decrease was more obvious in the treatment group (P < 0.05). The incidence of adverse reactions in treatment group was significantly lower than that in the control group (4.39% vs 10.99%, P < 0.05). Conclusion The effect of indacaterol combined with carbocysteine in treatment of chronic obstructive pulmonary disease in the elderly is remarkable, the clinical symptoms are relieved quickly, the combination can effectively improve the arterial oxygen and pulmonary function, reduce the inflammatory reaction, and the adverse reaction is less.

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