摘要目的：探讨布地奈德联合异丙托溴铵治疗慢性阻塞性肺疾病急性发作临床疗效，并观察治疗过程中的不良反应，分析其治疗的安全性，为临床治疗提供依据。方法选择慢性阻塞性肺疾病急性加重期患者160例，根据入院编号随机分为对照组 A、B、C 和观察组四组，各40例，对照组 A 应用泼尼松等常规治疗，对照组 B 应用氨茶碱等常规治疗；对照组 C 应用泼尼松、氨茶碱等常规治疗，对照组均予以0．9％氯化钠注射液作为安慰剂雾化吸入；观察组在对照组基础上应用布地奈德联合异丙托溴铵治疗。观察各组治疗效果、检测治疗前后血液二氧化碳分压（PaO2）、血氧分压（PaCO2）、一秒钟用力呼气量（FEV1）、一秒钟用力呼气量（FEV1）和一秒钟用力呼气量占用力肺活量 FVC 的比值（FEV1／FVC），并观察患者不良反应，评价其安全性。结果观察组总有效率为95．00％（38／40），高于对照组 A、B、C，差异有统计学意义（χ2＝9．68、9．70、9．91，均 P ＜0．05）；观察组治疗后 PaO2（76．89±0．63）mmHg，高于对照组 A、B、C 治疗后，且各组治疗后均高于治疗前，差异均有统计学意义（t ＝10．48、13．72、12．83，均 P ＜0．05）；观察组治疗后 PaCO2（50．06±0．60）mmHg，低于对照组 A、B、C 治疗后，且各组治疗后均低于治疗前，差异均有统计学意义（t ＝11．72、12．69、10．74，均 P ＜0．05）；观察组治疗后 FEV1和 FEV1／FVC 分别为（2．19±0．29）L 和（69．27±4．59）％，均高于对照组 A、B、C 治疗后，且各组治疗后均高于治疗前，差异均有统计学意义（t ＝12．68、13．10、12．41、9．89、10．63、11．29，均 P ＜0．05）；各组患者不良反应比较，差异无统计学意义（χ2＝1．38，P ＞0．05）。结论布地奈德联合异丙托溴铵治疗慢性阻塞性肺疾病急性发作患者具有较好的临床疗效，能够显著提高患者肺功能，缩短好转时间，并具有较高的安全性，值得临床推广应用。

abstractsObjective To explore the effect of budesonide combined with ipratropium bromide in the treat-ment of acute exacerbations of chronic obstructive pulmonary disease,and observe the adverse reactions during treat-ment.To analyze the treatment of safety and to provide the basis for clinical treatment.Methods 160 cases of acute exacerbations of chronic obstructive pulmonary disease were selected,they were randomly divided into the control group A,B,C and the observation group,with 40 cases in each group.The control group A was treated with prednisone and other conventional,control group B was treated with aminophylline and other conventional treatment,the control group C application included prednisone,aminophylline and other conventional treatment,all the control group were treated with 0.9% sodium chloride solution inhaled as a placebo spray.And the observation group application of budesonide was combined with ipratropium bromide based on the routine treatment.Mainly the effect of treatment was observed,and the blood carbon dioxide partial pressure (PaO2 ),partial pressure of oxygen (PaCO2 ),forced expiratory volume in one second (FEV1 ),forced expiratory volume in one second (FEV1 )and forced expiratory volume in one second to forced vital capacity ratio of FVC (FEV1 /FVC)before and after treatment were detected.And the adverse reactions were observed to evaluate its safety.Results The total effective rate of the observation group was 95.00%(38 /40),which were higher than the control group A,B and C,the differences were statistically significant (χ2 =9.68,9.70,9.91,all P <0.05).The PaO2 level of the observation group after treatment was (76.89 ±0.63)mmHg, which were higher than that of the control group after treatment (73.66 ±0.47)mmHg,and that of two groups after treatment were higher than those before treatment,the differences were statistically significant (t =10.48,13.72,12.83,all P <0.05).The PaCO2 of the observation group after treatment was (50.06 ±0.60)mmHg,which were lower than that of the control group A,B and C after the treatment,each group after treatment was lower than that before treatment,the differences were statistically significant (t =11.72,12.69,10.74,all P <0.05 ).FEV1 and FEV1 /FVC of the observation group after treatment were (2.19 ±0.29)L and (69.27 ±0.59)%,which were higher than those of the control group A,B and C after treatment,and each groupafter treatment was higher than that before treatment,the differences were statistically significant (t =12.68,13.10,12.41,9.89,10.63,11.29,all P <0.05). Comparison of adverse reactions in each group,the difference was not statistically significant (χ2 =1.38,P >0.05). Conclusion It has good clinical curative effect on budesonide combined with ipratropium bromide for the treatment of acute exacerbations of chronic obstructive pulmonary disease patients,which can significantly improve the pulmona-ry function of patients,shorten recovery time,and has high security.It is worthy of clinical application.