探讨不同剂量糖皮质激素联合特布他林雾化吸入治疗老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）急性加重期（AECOPD）的临床效果和安全性。

选取新疆维吾尔自治区人民医院2016年1月至2017年5月收治的128例AECOPD患者作为研究对象，其中64例患者采用2 mg/d布地奈德联合特布他林雾化吸入治疗（小剂量组），另外64例患者采用4 mg/d布地奈德联合特布他林雾化吸入治疗（大剂量组）。观察两组患者治疗前后第1秒呼气容积（forced expiratory volume in first second, FEV1）、用力呼气容积（forced expiratory volume, FVC）及FEV1/FVC、动脉血氧分压（PaO₂）和动脉血二氧化碳分压（PaCO₂），同时观察两组患者临床症状和体征的缓解时间、治疗效果和不良反应发生率。

治疗前，两组患者FEV1、FVC、FEV1/FVC、PaO₂、PaCO₂的差异均无统计学意义（均P>0.05）。治疗后，两组患者的FEV1、FVC、FEV1/FVC、PaO₂均较治疗前明显升高，PaCO₂均较治疗前明显降低，差异均有统计学意义（t=3.141、2.513、4.128、5.018、5.780，4.026、4.187、5.831、7.340、7.011；均P<0.05）；而且与小剂量组比较，大剂量组FEV1、FVC、FEV1/FVC、PaO₂升高更明显，PaCO₂降低更明显，差异均有统计学意义（t=2.435、2.052、2.196、2.337、2.418，P<0.05）。治疗后，与小剂量组比较，大剂量组喘息缓解时间、咳嗽消失时间、哮鸣音消失时间均明显缩短，均有统计学意义（t=2.613、2.859、2.781，均P<0.05）。另外，大剂量组总有效率明显高于小剂量组，差异有统计学意义（χ²=4.873，P<0.05）。两组患者不良反应发生率的差异无统计学意义（χ²=0.061，P>0.05）。

大剂量糖皮质激素联合特布他林治疗老年AECOPD可改善肺功能和动脉血气，缩短症状和体征缓解时间，提高临床疗效，未增加不良反应发生率，值得临床推广应用。

To study the effects and safety of different doses of glucocorticoid combined with terbutaline inhalation in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

128 patients with AECOPD were selected. Patients were randomly divided into two groups. Sixty four patients in the group A were treated with low dose budesonide (2 mg/d) combined with terbutaline inhalation, and the 64 patients in the group B were treated with high dose budesonide (2 mg/d) combined with terbutaline inhalation. The forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and FEV1/FVC, arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂) of two groups were observed before and after treatment, and the clinical symptoms and signs remission time, treatment effect and adverse reaction rate of two groups were statistically analyzed.

After treatment, the FEV1, FVC, FEV1/FVC, PaO₂ and effective rate in group B were significantly higher than those in group A, and the difference were statistically significant (t=3.141, 2.513, 4.128, 5.018, 5.780, 4.026, 4.187, 5.831, 7.340, 7.011, P<0.05). The PaCO₂, symptoms and signs remission time of group B were significantly lower than those of group A, and the difference were statistically significant (t=2.435, 2.052, 2.196, 2.337, 2.418, P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (χ²=0.061, P>0.05).

High dose glucocorticoid combined with terbutaline in the treatment of AECOPD can improve the pulmonary function and arterial blood gas, shorten the remission time of symptoms and symptoms, improve the clinical efficacy, and does not increase the incidence of adverse reactions.