目的 探讨清气化痰丸联合沙美特罗替卡松治疗慢性阻塞性肺疾病急性加重期的临床疗效。方法 选取2021年4月—2022年4月北京市东城区第一人民医院收治的86例慢性阻塞性肺疾病急性加重期患者，按随机数字表法将所有患者分为对照组和治疗组，每组各43例。对照组吸入沙美特罗替卡松粉吸入剂，1吸/次，2次/d。治疗组在对照组基础上口服清气化痰丸，6 g/次，2次/d。两组疗程均为14 d。观察两组的临床疗效，比较两组呼吸系统表现缓解时间及治疗前后慢阻肺晨间症状量表（COPD-MSD）评分、血气及肺功能指标和炎症指标水平。结果 治疗后，治疗组总有效率是95.35%，较对照组的81.40%显著提高（P＜0.05）。治疗后，治疗组呼吸困难、咳嗽、咳痰、肺部哮鸣音缓解时间均较对照组显著缩短（P＜0.05）。治疗后，两组COPD-MSD中“今天早晨”的症状、“昨晚睡觉后”的症状评分及其总分均显著降低（P＜0.05）；且治疗后，治疗组COPD-MSD评分显著低于对照组（P＜0.05）。治疗后，两组二氧化碳分压（pCO₂）均显著降低，动脉血氧分压（pO₂）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）、FEV1%pred均显著增加（P＜0.05），均以治疗组改善更显著（P＜0.05）。治疗后，两组外周血C反应蛋白（CRP）、中性粒细胞与淋巴细胞比值（NLR）、嗜酸性粒细胞（EOS）计数及呼出气一氧化氮（FeNO）、血清血清趋化因子配体18（CCL18）水平均显著下降（P＜0.05）；且治疗后，治疗组外周血CRP、NLR、EOS计数及FeNO、血清CCL18水平均显著低于对照组（P＜0.05）。结论 清气化痰丸联合沙美特罗替卡松治疗慢阻肺急性加重期患者可获得良好疗效，能有效减轻患者呼吸系统表现，改善晨间症状及动脉血气和肺功能状态，缓解机体炎症，安全性好，值得临床推广应用。

Objective To explore the clinical efficacy of Qingqi Huatan Pills combined with salmeterol ticasone in treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods A total of 86 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Dongcheng District First People's Hospital of Beijing from April 2021 to April 2022 were selected and divided into control group and treatment group according to random number table, with 43 cases in each group. Patients in the control group were given Salmeterol Xinafoate and Fluticasone Propionate Powder for Inhalation, 1 puff/time, twice daily. Patients in the treatment group were po administered with Qingqi Huatan Pills on the basis of the control group, 6 g/time, twice daily. The treatment course of both groups was 14 d. The clinical effects of the two groups were observed, and the remission time of respiratory manifestations, COPD Morning Symptom Scale (MSD) scores, blood gas and lung function indexes and inflammation indexes before and after treatment were compared between the two groups. Results After treatment, the total effective rate of the treatment group was 95.35%, which was significantly higher than that of the control group (81.40%) (P < 0.05). After treatment, the remission time of dyspnea, cough, sputum, and pulmonary wheezing in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, "this morning" symptom score, "after sleeping last night" symptom score and total score in both groups were significantly decreased (P < 0.05). After treatment, the COPD-MSD score in the treatment group was significantly lower than that in the control group (P < 0.05). After treatment, the partial pressure of carbon dioxide (pCO₂) was significantly decreased, while the partial pressure of oxygen (pO₂), forced expiratory volume/forced vital capacity at the first second (FEV₁/FVC) and FEV₁%pred were significantly increased in both groups (P < 0.05), and the improvement was more significant in the treatment group (P < 0.05). After treatment, peripheral blood C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), eosinophilic granulocyte (EOS) count, exhaled nitric oxide (FeNO) and serum chemokine ligand 18 (CCL18) levels in both groups were significantly decreased (P < 0.05). After treatment, CRP, NLR, EOS, FeNO, and CCL18 levels in peripheral blood of the treatment group were significantly lower than those of the control group (P < 0.05). Conclusion Qingqi Huatan Pills combined with salmeterol ticasone has good curative effect in treatment of acute exacerbation of chronic obstructive pulmonary disease, and can effectively reduce the respiratory system performance of patients, improve morning symptoms, arterial blood gas and lung function, relieve body inflammation with good safety, which is worthy of clinical application.

R974

北京市东城区第一人民医院科研项目（东一研[2020]-18）