目的 探討清氣化痰丸聯(lián)合沙美特羅替卡松治療慢性阻塞性肺疾病急性加重期的臨床療效。方法 選取2021年4月—2022年4月北京市東城區(qū)第一人民醫(yī)院收治的86例慢性阻塞性肺疾病急性加重期患者，按隨機數(shù)字表法將所有患者分為對照組和治療組，每組各43例。對照組吸入沙美特羅替卡松粉吸入劑，1吸/次，2次/d。治療組在對照組基礎上口服清氣化痰丸，6 g/次，2次/d。兩組療程均為14 d。觀察兩組的臨床療效，比較兩組呼吸系統(tǒng)表現(xiàn)緩解時間及治療前后慢阻肺晨間癥狀量表（COPD-MSD）評分、血氣及肺功能指標和炎癥指標水平。結果 治療后，治療組總有效率是95.35%，較對照組的81.40%顯著提高（P＜0.05）。治療后，治療組呼吸困難、咳嗽、咳痰、肺部哮鳴音緩解時間均較對照組顯著縮短（P＜0.05）。治療后，兩組COPD-MSD中“今天早晨”的癥狀、“昨晚睡覺后”的癥狀評分及其總分均顯著降低（P＜0.05）；且治療后，治療組COPD-MSD評分顯著低于對照組（P＜0.05）。治療后，兩組二氧化碳分壓（pCO₂）均顯著降低，動脈血氧分壓（pO₂）、第1秒用力呼氣容積/用力肺活量（FEV1/FVC）、FEV1%pred均顯著增加（P＜0.05），均以治療組改善更顯著（P＜0.05）。治療后，兩組外周血C反應蛋白（CRP）、中性粒細胞與淋巴細胞比值（NLR）、嗜酸性粒細胞（EOS）計數(shù)及呼出氣一氧化氮（FeNO）、血清血清趨化因子配體18（CCL18）水平均顯著下降（P＜0.05）；且治療后，治療組外周血CRP、NLR、EOS計數(shù)及FeNO、血清CCL18水平均顯著低于對照組（P＜0.05）。結論 清氣化痰丸聯(lián)合沙美特羅替卡松治療慢阻肺急性加重期患者可獲得良好療效，能有效減輕患者呼吸系統(tǒng)表現(xiàn)，改善晨間癥狀及動脈血氣和肺功能狀態(tài)，緩解機體炎癥，安全性好，值得臨床推廣應用。

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

北京市東城區(qū)第一人民醫(yī)院科研項目（東一研[2020]-18）