目的 探討噻托溴銨聯(lián)合莫西沙星治療輕中度慢性阻塞性肺疾病急性加重期的臨床療效。方法 回顧性收集2019年12月—2022年11月首都醫(yī)科大學北京友誼醫(yī)院平谷醫(yī)院呼吸科收治的78例輕中度慢性阻塞性肺疾病急性加重期患者的病例資料，根據(jù)治療方案的不同將患者分為對照組和治療組，每組各39例。對照組靜脈滴注鹽酸莫西沙星氯化鈉注射液，0.4 g/次，每次輸液時間≥90 min。治療組在對照組基礎上使用噻托溴銨吸入粉霧劑，1粒/次，通過粉霧吸入器吸入給藥裝置吸入使用，1次/d。兩組療程為10 d。觀察兩組臨床療效，比較治療前后兩組咳嗽、咳痰評估問卷（CASA-Q）評分、血氣分析指標、改良版英國醫(yī)學研究委員會呼吸困難問卷（mMRC）評分及外周血中性粒細胞與淋巴細胞比值（NLR）、血小板與淋巴細胞比值（PLR）和血清C反應蛋白（CRP）水平。結果 治療后，治療組總有效率是97.44%，較對照組的79.49%顯著提高（P＜0.05）。治療后，兩組CASA-Q中咳嗽癥狀、咳嗽影響、咳痰癥狀、咳痰影響評分及其總分均較治療前顯著增加（P＜0.05）；且治療后，治療組CASA-Q評分高于對照組（P＜0.05）。治療后，兩組動脈血氧分壓（pO₂）均顯著上升，而動脈血二氧化碳分壓（pCO₂）均顯著下降（P＜0.05）；且治療后，治療組患者血氣指標改善優(yōu)于對照組（P＜0.05）。治療后，兩組患者mMRC評分均顯著降低（P＜0.05）；且治療后，治療組mMRC評分低于對照組（P＜0.05）。治療后，兩組外周血NLR、PLR和血清CRP水平均顯著下降（P＜0.05）；且治療后，NLR、PLR和血清CRP水平均以治療組降低更顯著（P＜0.05）。結論 噻托溴銨聯(lián)合莫西沙星治療輕中度慢性阻塞性肺疾病急性加重期患者具有良好的療效，能安全有效地緩解患者呼吸道癥狀，改善動脈血氣和肺功能，調節(jié)機體炎癥狀態(tài)。

Objective To investigate the clinical efficacy of tiotropium combined with moxifloxacin in treatment of acute exacerbation of mild to moderate chronic obstructive pulmonary disease. Methods Data of 78 patients with acute exacerbation of mild to moderate chronic obstructive pulmonary disease admitted to the Respiratory Department of Pinggu Hospital, Beijing Friendship Hospital Affiliated to Capital Medical University from December 2019 to November 2022 were retrospectively collected. According to different treatment plans, the patients were divided into control group and treatment group, with 39 cases in each group. Patients in the control group were iv administered with Moxifloxacin Hydrochloride and Sodium Chloride Injection, 0.4 g/time, each infusion time ≥ 90 min. Patients in the treatment group were given Tiotropium Bromide Powder for inhalation on the basis of the control group, 1 capsule/time, and the drug delivery device was inhaled through a powder mist inhaler, once daily. The two groups were treated for 10 d. The clinical efficacy of the two groups was observed. The scores of Cough and Sputum Assessment Questionnaire (CASA-Q) score, blood gas analysis indexes, modified Medical Research Council Dyspnea Questionnaire (mMRC) score, peripheral blood neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and serum C-reactive protein (CRP) were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 97.44%, which was significantly higher than that of the control group (79.49%) (P＜0.05). After treatment, the scores of cough symptoms, cough effects, sputum symptoms, sputum effects and total scores of CASA-Q in 2 groups were significantly increased compared with those before treatment (P＜0.05). After treatment, the CASA-Q score in the treatment group was higher than that in the control group (P＜0.05). After treatment, the arterial partial pressure of oxygen (pO₂) increased significantly, while the arterial partial pressure of carbon dioxide (pCO₂) decreased significantly in both groups (P＜0.05). After treatment, the blood gas index in the treatment group was better than that in the control group (P＜0.05). After treatment, mMRC scores in both groups were significantly decreased (P＜0.05). After treatment, the mMRC score of the treatment group was lower than that of the control group (P＜0.05). After treatment, the levels of peripheral blood NLR, PLR, and serum CRP in both groups were significantly decreased (P＜0.05). After treatment, the levels of NLR, PLR, and serum CRP were significantly decreased in the treatment group (P＜0.05). Conclusion Tiotropium combined with moxifloxacin has a good therapeutic effect in treatment of acute exacerbation of mild to moderate chronic obstructive pulmonary disease, and can safely and effectively relieve respiratory symptoms, improve arterial blood gas and lung function, which can regulate the inflammatory state of the body.

R974

吳階平醫(yī)學基金會臨床科研專項資助基金（320.6750.18528）