吴河凤+陈文海+刘春妮��

【摘要】目的分析噻托溴铵联合沙美特罗替卡松气雾剂治疗老年慢性阻塞性肺疾病（COPD）的应用效果。

方法以2015年4月至2016年3月间收治的70例老年COPD患者为研究对象，随机分为观察组与对照组各35例，两组患者皆给予常规基础治疗，对照组患者予50 μg沙美特罗与250 μg替卡松气雾剂进行吸入治疗，每天2次；观察组患者在此基础上给予18 μg噻托溴铵干粉吸入治疗，每天1次。两组患者治疗疗程均为3个月，随访观察6个月。

结果观察组患者FEV1、FEV1/FVC、FEV1占预计值百分比等肺功能指标明显优于对照组，治疗6个月后急性加重发作次数和产生医疗费用皆明显低于对照组，差异有统计学意义（P<0.001）。观察组与对照组总并发症发生率分别为11.43%与17.14%，差异无统计学意义（P>0.05）。

结论采用噻托溴铵联合沙美特罗替卡松气雾剂治疗老年慢性阻塞性肺疾病，能明显改善肺功能指标，降低急性发作风险，减轻医疗负担，安全性高，值得应用与推广。

【关键词】噻托溴铵；沙美特罗；替卡松；老年；慢性阻塞性肺疾病；肺功能

中图分类号：R563文献标识码：ADOI：10.3969/j.issn.10031383.2017.02.021

【Abstract】ObjectiveTo explore the effect of salmeterol xinafoate combined with fluticasone propionate aerosol and tiotropium bromide in the treatment of elderly patients with chronic obstructive pulmonary disease（COPD）.

Methods70 cases of elderly patients with COPD admitted to hospital from April，2015 to March，2016 were selected as study objects，and they were randomly divided into observation group and control group with 35 cases in each group.Both groups were given conventional basic treatment.The control group were given 50 μg of salmeterol xinafoate and 250 μg of fluticasone propionate aerosol inhalation therapy，twice a day，based on which，the observation group were added 18 μg of tiotropium bromide dry powder inhalation therapy，once a day.Both groups were treated for 3 months，and were followed up for 6 months.

ResultsPulmonary function parameters like percentage of predicted value of FEV1，FEV1/FVC，FEV1 of the observation group were significantly better than those of the control group.After 6 months of treatment，number of acute exacerbation attacks and medical expenses were significantly less than those of the control group，difference was statistically significant（P<0.001）.The incidence of complications in the observation group and control group were 11.43% and 17.14% respectively，difference was not statistically significant（P>0.05）.

ConclusionSalmeterol xinafoate combined with fluticasone propionate aerosol and tiotropium bromide in the treatment of elderly patients with COPD can improve pulmonary function indexes，reduce the risk of acute attack，which can reduce the burden of medical treatment with high safety.Thus，it is worthy of application and promotion.

【Key words】tiotropium bromide；salmeterol xinafoate；fluticasone propionate；the elderly；COPD；pulmonary function

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）又簡称为慢阻肺，是临床上发病率较高的呼吸系统疾病之一，主要表现为不完全可逆的持续气流受限，严重影响患者生活质量的同时，也是其他呼吸系统疾病的重要诱发因素，可直接威胁患者的生命安全[1～2]。慢阻肺患者主要为老年人群，与长期吸烟、接触有毒有害气体等有关，积极采取科学有效的方案进行治疗显得至关重要[3]。目前临床上首选支气管扩张药物治疗，但临床疗效并不佳[4]。……