目的 探讨沙美特罗替卡松联合噻托溴铵对慢性阻塞性肺疾病（慢阻肺）急性加重期的治疗效果。方法 选取2018年12月-2019年12月榆林市第二医院收治的200例慢阻肺急性加重期患者作为研究对象，应用随机数字分组法将患者随机分为对照组（n=66）、观察1组（n=67）、观察2组（n=67）。对照组患者在常规治疗基础上吸入18 μg的噻托溴铵粉吸入剂；观察1组患者在对照组治疗基础上给予1 mL沙丁胺醇气雾剂和2 mL生理盐水配比雾化吸入治疗，2次/d；观察2组患者在对照组治疗基础上应用沙美特罗替卡松粉吸入剂治疗，1吸/次，2次/d。3组患者均连续治疗14 d后评定治疗效果。观察3组患者的临床疗效，同时比较3组治疗前后的肺功能指标与炎性因子水平。结果 治疗后，对照组治疗总有效率为71.21%，观察1组为85.07%，观察2组为94.03%，观察2组显著高于对照组（P<0.05）。治疗后，3组患者呼气峰流速（PEF）、第一秒用力呼气量（FEV₁）水平均上升（P<0.05），且观察2组高于观察1组及对照组（P<0.05）。治疗后，3组患者超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）水平显著降低，白细胞介素-10（IL-10）显著升高（P<0.05）；且观察2组优于观察1组及对照组（P<0.05）。结论 对慢阻肺急性加重期患者应用沙美特罗替卡松联合噻托溴铵治疗，能够提升治疗效果、改善肺功能，减少患者炎症反应，安全性好。

Objective To investigate the therapeutic effect of salmeterol xinafoate and fluticasone propionate combined with tiotropium bromide in treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods A total of 200 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Yulin Second Hospital from December 2018 to December 2019 were selected as the research subjects, and the patients were randomly divided into control group (n=66), observation group 1 (n=67) and observation group 2 (n=67) by random number grouping method. Patients in the control group were given Tiotropium Bromide Powder for Inhalation 18 μg on the basis of conventional treatment. Patients in the observation group 1 were given 1 mL Salbutamol Aerosol and 2 mL normal saline on the basis of control group, twice daily. Patients in the observation 2 groups were treated with Salmeterol Xinafoate and Fluticasone Propionate Powder for Inhalation on the basis of control group, 1 inhalation/time, twice daily. All patients in the 3 groups were evaluated after continuous treatment for 14 d. Clinical efficacy of three groups was observed, and lung function indexes and inflammatory factors before and after treatment in the three groups were compared. Results After treatment, the total effective rate of control group was 71.21%, observation group 1 was 85.07%, observation group 2 was 94.03%, observation group 2 was significantly higher than control group (P<0.05). After treatment, the levels of PEF and FEV 1 in three groups were increased (P<0.05), and the levels of PEF and FEV₁ in the observation group 2 was higher than observation group 1 was and higher than control group (P<0.05). After treatment, the levels of hs-CRP and IL-6 in three groups were significantly decreased, and IL-10 was significantly increased (P<0.05). And the levels of hs-CRP, IL-6, and IL-10 in the observation group 2 was better than observation group 1, and better than control group (P<0.05). Conclusion The application of salmeterol xinafoate and fluticasone propionate combined with tiotropium bromide in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease can improve the treatment effect, lung function, reduce the inflammatory response of patients, and have good safety.

R974