目的探讨中-重度稳定期慢性阻塞性肺疾病(COPD)老年患者应用沙美特罗替卡松气雾剂(舒利迭)的最佳剂量。方法选取2013—2015年新余市人民医院收治的中-重度稳定期COPD老年患者300例,随机分为对照组、低剂量组和高剂量组,各100例。其中对照组患者给予常规治疗,低剂量组和高剂量组患者在对照组基础上分别给予50/250μg、50/500μg舒利迭吸入治疗。观察3组患者治疗前后肺功能、6min步行试验(6-MWD)及动脉血气分析指标、临床症状评分和不良反应发生情况。结果治疗前3组患者第1秒用力呼气末容积(FEV1)、FEV1/用力肺活量(FEV1/FVC)和FEV1占预计值百分比(FEV1%)、6-MWD比较,差异无统计学意义(P>0.05);治疗后低剂量组、高剂量组患者FEV1、FEV1/FVC、FEV1%、6-MWD高于对照组,高剂量组患者FEV1、FEV1/FVC、FEV1%、6-MWD高于低剂量组,差异有统计学意义(P<0.05);治疗前3组患者临床症状评分、动脉血气分析指标比较,差异无统计学意义(P>0.05),治疗后低剂量组、高剂量组患者临床症状评分、Pa CO2低于对照组,高剂量组临床症状评分、Pa CO2低于低剂量组,低剂量组、高剂量组患者Pa O2高于对照组,高剂量组患者Pa O2高于低剂量组,差异有统计学意义(P<0.05)。3组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论舒利迭能有效改善中-重度稳定期COPD疾病老年患者肺功能、临床症状以及血气分析指标,高剂量时改善效果更佳,且无明显不良反应。 Objective To investigate the optimal dosage of salmeterol and fluticasone-aerosol (seretide) in elderly patients with moderate-severe chronic obstructive pulmonary disease (COPD). Methods 300 elderly patients with moderate to severe stable COPD admitted to Xinyu Municipal People’s Hospital from 2013 to 2015 were randomly divided into control group, low dose group and high dose group, with 100 cases each. Patients in the control group were given routine treatment, while patients in the low-dose group and high-dose group were given 50 / 250μg and 50 / 500μg of seretide respectively on the basis of the control group. Lung function, 6-minute walk test (6-MWD) and arterial blood gas analysis index, clinical symptom scores and adverse reactions were observed before and after treatment in 3 groups. Results The FEV1, FEV1 / FVC and FEV1% FEV1% and 6-MWD in the 3 groups before treatment did not show significant difference (P > 0.05). After treatment, FEV1, FEV1 / FVC, FEV1% and 6-MWD in low-dose group and high-dose group were higher than those in control group. FEV1, FEV1 / FVC, FEV1% Dose group, the difference was statistically significant (P <0.05); before treatment, the clinical symptom score and arterial blood gas analysis index in the three groups had no significant difference (P> 0.05); after the treatment, the patients in the low dose group and the high dose group PaO2 was lower in the clinical symptoms score, PaO2 in the high dose group, PaO2 in the low dose group than in the low dose group, PaO2 in the high dose group was higher than that in the control group, PaO2 in the high dose group was higher than that in the low dose group Dose group, the difference was statistically significant (P <0.05). There was no significant difference in the incidence of adverse reactions between the three groups (P> 0.05). Conclusion Seretide can effectively improve pulmonary function, clinical symptoms and blood gas analysis indexes of elderly patients with moderate-severe COPD disease. The improvement effect is better at high dosage without obvious adverse reactions.