目的 探究沙美特罗替卡松粉吸入剂联合噻托溴铵吸入剂在慢性阻塞性肺疾病（COPD）急性加重期治疗中的应用价值。方法 将240例在河南省人民医院呼吸与危重症医学科治疗的COPD急性加重期患者作为研究对象，随机分成对照组和观察组，对照组采用以噻托溴铵吸入剂为主的基础治疗，观察组采用噻托溴铵吸入剂联合沙美特罗替卡松粉吸入剂治疗，比较两组人员的治疗效果、肺功能指标以及炎症因子水平。结果 与治疗前比较，治疗14 d后，对照组与观察组的用力肺活量（FVC）、第1秒用力呼气量（FEV1）、最大呼气流量（PEF）、第1秒用力呼气量占预计值的百分比（FEV1%）及每分钟最大通气量（MVV）均显著升高，且观察组显著高于对照组（P<0.05）。与治疗前比较，治疗后对照组、观察组氧分压（PaO₂）、氧饱和度（SaO₂）均显著升高，而二氧化碳分压（PaCO₂）均显著下降（P<0.05）；治疗14 d后，观察组SaO₂和PaO₂显著高于对照组，而PaCO₂显著低于对照组（P<0.05）。治疗14 d后，对照组与观察组的气管壁厚度（WT）、器官壁总面积（WA）、管壁厚度/外径（T/D）均显著降低，官腔面积（AI）水平显著升高，且观察组均显著优于对照组（P<0.05）。对照组与观察组的血清降钙素原（PCT）、白细胞介素-6（IL-6）、C反应蛋白（CRP）水平均显著降低，可溶性肿瘤坏死因子受体（sT-NFR）水平显著升高，且观察组显著优于对照组（P<0.05）。对照组与观察组的圣乔治呼吸问卷（SGRQ）评分均显著降低，且观察组显著低于对照组（P<0.05）。结论 噻托溴铵联合沙美特罗替卡松能够明显改善COPD急性加重期患者的肺功能、减轻炎症反应、提高生活质量。

Objective To explore the value of tiotropium joint salmeterol fluticasone for Inhalation in the treatment of acute exacerbation of COPD. Methods 240 patients with acute exacerbation of COPD treated in Henan People's Hospital were randomly divided into A group and B group. Group A received basic treatment mainly with tiotropium bromide inhalation, while B group was treated with tiotropium joint salmeterol fluticasone for Inhalation. The therapeutic effects, pulmonary function and inflammatory factors were compared between the two groups. Results After 14 days of treatment, FVC, FEV1, PEF, FEV1% and MVV of the observation and control group were significantly higher than before treatment, and the index of control group were significantly higher than observation group (P<0.05). After 14 days of treatment, PaO₂ and SaO₂ of the observation and control group were significantly higher than before treatment, PaCO₂ was significantly lower, and the index of control group were significantly higher than observation group (P<0.05). After 14 days of treatment, the thickness of trachea wall (WT), the total area of organ wall (WA) and the thickness/outer diameter of tube wall (T/D) of the observation and control group were significantly lower than before treatment, and the index of control group were significantly higher than observation group (P<0.05), the level of lumen area (AI) in the observation group was significantly higher than that in the control group (P<0.05). The levels of procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP) in the control and observation group were lower than those before treatment, and the levels of soluble tumor necrosis factor receptor (st NFR) were higher than those before treatment, the index in observation group was better than control group (P<0.05). The SGRQ score of the control and observation group was lower than than those before treatment, SGRQ score of observation group was lower than that of control group, the difference was significant (P<0.05). Conclusion Tiotropium bromide combined with salmeterol/fluticasone can obviously improve the lung function, relieve the inflammatory response and the quality of life in the patients with acute exacerbation of COPD, and it has a good effect.

R969;R974