目的:研究联合吸入噻托溴铵和沙美特罗/氟替卡松治疗慢性阻塞性肺病的临床效果。方法: 将中
重度慢性阻塞性肺病病人随机分成观察组和对照组，每组30 例。所有病人均给予常规抗感染、吸氧、化痰和平
喘对症治疗。对照组给予沙美特罗/氟替卡松50 /500μg，2 次/d，观察组在此基础上加用噻托溴铵18μg，1 次/d。
观察2 组治疗前及治疗8 wk 后的临床症状、肺功能及动脉血气变化。结果:治疗前2 组肺功能及动脉血气差异
均无统计学意义( P ＞ 0． 05) ;观察组治疗8wk 后第一秒用力呼气容积( FEV1 ) 、FEV1 /FVC( 用力肺活量) ( %) 、
FEV1 占预计值百分比( FEV1%) 显著提高，临床症状和动脉血气指标明显改善，与对照组比较，差异有统计学意
义( P ＜ 0． 05) 。结论:联合使用噻托溴铵和沙美特罗/氟替卡松较单独使用沙美特罗/氟替卡松对中重度COPD
病人临床症状、肺功能及动脉血气有更加明显的改善作用。

Objective: To study the clinical efficacy on combined inhaled tiotropium bromide and
salmeterol /fluticasone in the treatment of chronic obstructive pulmonary disease( COPD) ． Methods: patients
with moderate and severe COPD were randomly divided into two groups( n = 30 for each group) ，
experimental group and control group． All patients were treated with routine anti － infection，oxygen inhalation，
relieving phlegm and anti － asthma． The control group was given Salmeterol /fluticasone( 50 /
500μg) twice daily，added tiotropium bromide 18 ug once daily to the observation group． Observe the
chang of clinical symptoms、pulmonary function examination and blood gas analysis before treatment
and after treatment eight weeks In two group．Result: There were no significant differences in the values
of pulmonary function and arterial blood gas before treatment between two groups( P ＞ 0． 05) ． forced
expiratory volume in 1 second( FEV1) 、FEV1 /FVC( forced vital capacity) 、FEV1%、clinical symptoms
and arterial blood gas index significantly improve after treatment eight weeks in patients of experimental
group，Compared with the control group， there were significant differences in the values( P ＜ 0． 05) ．
Conclusion: Combination therapy with tiotropium and Salmeterol /fluticason leads to better improved
clinical symptoms、lung function and arterial blood gas as compared to salmeterol /fluticasion alone in
the treatment of patients with moderate and severe COPD．

R563． 8

 收稿日期: 2013 － 11 － 27; 修回日期: 2014 － 01 － 16
基金项目: 国家自然基金( 81360227)
作者简介: 李瑞霞( 1973 － ) ，女，内蒙古自治区人民医院呼吸内科副主任医师，医学硕士。
通讯作者: 孙德珍，教授，E － mail: sdz@163． com． 内蒙古医科大学附属医院， 010050