NIPPV联合布地奈德/福莫特罗对AECOPD合并呼吸衰竭患者肺通气及炎症状态的影响
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摘要
目的:探讨无创正压机械通气(NIPPV)联合布地奈德/福莫特罗对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者肺通气及炎症状态的影响。方法:选取AECOPD合并呼吸衰竭患者115例,根据机械通气方式的不同将患者分为有创正压机械通气(IPPV)组(n=57)与NIPPV组(n=58)。结果:NIPPV组治疗总有效率(96.55%)明显高于IPPV组的84.21%(P<0.05)。治疗前,两组呼吸频率(RR)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)与潮气量(TV)比较差异无统计学意义(P>0.05),治疗后,两组RR与PaCO2明显低于治疗前,PaO2与TV明显高于治疗前(P<0.05),其中NIPPV组患者上述指标均明显优于IPPV组(P<0.05)。治疗前,两组血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)与肿瘤坏死因子(TNF-α)水平比较差异无统计学意义(P>0.05),治疗后,两组上述指标明显低于治疗前,其中NIPPV组明显低于IPPV组(P<0.05)。NIPPV组住院时间为(16.98±3.87)d,明显短于IPPV组的(24.16±5.18)d,P<0.05。NIPPV组VAP与病死率均为1.72%,明显低于IPPV组的17.55%和15.79%(P<0.05)。结论:NIPPV联合布地奈德/福莫特罗对AECOPD合并呼吸衰竭患者有助于明显改善肺通气功能,缓解炎症状态,进而改善预后状况,值得临床推广应用。
Objective:To study the influence of NIPPV combined budesonide/formoterol on pulmonary ventilation and inflammatory state of AECOPD patients with respiratory failure.Method:One hundred and fifteen cases of AECOPD patients with respiratory failure were selected.According to the type of mechanical ventilation,the patients were divided into IPPV group(n=57)and NIPPV group(n=58).Result:The total effective rate of NIPPV group(96.55%)was significantly higher than that of IPPV group(84.21%),P<0.05.Before treatment,the differences of RR,PaO2,PaCO2 and TV between two groups were not statistically significant(P>0.05).After treatment,RR and PaCO2 of the two groups were significantly lower than pre-therapy,PaO2 and TV were significantly higher than pre-therapy,P <0.05.And,the above parameters of in NIPPV group were significantly better than those in IPPV group,P <0.05.Before treatment,there were no statistically significant differences in the serum PCT,CRP,IL-6 and TNF-αcompared between two groups(P>0.05),while after treatment,the above parameters in two groups were lower than those pre-therapy,P<0.05.And above parameters in NIPPV group were lower than those in IPPV group,P<0.05.Length of stay in NIPPV group was significantly shorter than that in IPPV group,P<0.05.VAP and fatality rates of NIPPV group were all 1.72%,which were significantly lower than IPPV group(17.55%,15.79%),P<0.05.Conclusion:NIPPV combined budesonide/formoterol might improve pulmonary ventilation and relieve inflammatory state of AECOPD patients with respiratory failure,and improve prognosis,which is worthy of clinical popularization and application.
Objective:To study the influence of NIPPV combined budesonide/formoterol on pulmonary ventilation and inflammatory state of AECOPD patients with respiratory failure.Method:One hundred and fifteen cases of AECOPD patients with respiratory failure were selected.According to the type of mechanical ventilation,the patients were divided into IPPV group(n=57)and NIPPV group(n=58).Result:The total effective rate of NIPPV group(96.55%)was significantly higher than that of IPPV group(84.21%),P<0.05.Before treatment,the differences of RR,PaO2,PaCO2 and TV between two groups were not statistically significant(P>0.05).After treatment,RR and PaCO2 of the two groups were significantly lower than pre-therapy,PaO2 and TV were significantly higher than pre-therapy,P <0.05.And,the above parameters of in NIPPV group were significantly better than those in IPPV group,P <0.05.Before treatment,there were no statistically significant differences in the serum PCT,CRP,IL-6 and TNF-αcompared between two groups(P>0.05),while after treatment,the above parameters in two groups were lower than those pre-therapy,P<0.05.And above parameters in NIPPV group were lower than those in IPPV group,P<0.05.Length of stay in NIPPV group was significantly shorter than that in IPPV group,P<0.05.VAP and fatality rates of NIPPV group were all 1.72%,which were significantly lower than IPPV group(17.55%,15.79%),P<0.05.Conclusion:NIPPV combined budesonide/formoterol might improve pulmonary ventilation and relieve inflammatory state of AECOPD patients with respiratory failure,and improve prognosis,which is worthy of clinical popularization and application.
引文
[1]Samp J C,Joo M J,Schumock G T,et al.Predicting Acute Exacerbations in Chronic Obstructive Pulmonary Disease[J].J Manag Care Spec Pharm,2018,24(3):265-279.
[2]舒利迭.布地奈德福莫特罗粉吸入剂[J].中国呼吸与危重监护杂志,2014,13(5):428-428.
[3]张婷,史菲,酆孟洁.超敏C反应蛋白/白蛋白比值对无创通气治疗AECOPD合并呼吸衰竭患者的预后评估价值[J].广东医学,2018,39(4):533-536.
[4]朱幼鸣,胡辉,曾烨.无创正压通气辅助治疗对COPD合并II型呼吸衰竭患者血气参数、心功能及炎症状态的影响[J].海南医学院学报,2017,23(3):327-330.
[5]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中国医学前沿杂志(电子版),2014,6(2):484-491.
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[7]Hempel G,Simon P,Salz P,et al.Respiratory Failure:Innovations in Diagnostics and Therapy[J].Anasthesiol Intensivmed Notfallmed Schmerzther,2018,53(2):126-140.
[8]许俊旭,王聪,郝金香.COPD急性加重并发Ⅱ型呼吸衰竭疑诊合并急性肺血栓栓塞症抗凝治疗的临床观察[J].广东医学,2018,39(2):255-258.
[9]Goto T,Hirayama A,Faridi M K,et al.Obesity and Severity of Acute Exacerbation of Chronic Obstructive Pulmonary Disease.[J].Ann Am Thorac Soc,2018,15(2):184-191.
[10]Goto T,Faridi M K,Camargo C A,et al.The association of aspirin use with severity of acute exacerbation of chronic obstructive pulmonary disease:a retrospective cohort study[J].NPJ Prim Care Respir Med,2018,28(1):7-7.
[11]林怀印,张敏,孟肖.细辛脑注射液联合纳络酮治疗慢性肺心病呼吸衰竭的临床研究[J].现代药物与临床,2018,33(4):817-822.
[12]张春美,丁震,裴罛,等.无创机械通气联合经管道雾化吸入布地奈德治疗AECOPD合并Ⅱ型呼吸衰竭的疗效[J].实用医学杂志,2015,11(5):819-820.
[13]周梅芬.机械通气辅助治疗在重症哮喘并发呼吸衰竭急诊抢救中的应用效果[J].世界最新医学信息文摘,2018,18(2):69-69.
[14]陈春芬,徐德祥.滴定呼气灵敏度在AECOPD合并呼吸衰竭患者无创正压通气治疗中的应用[J].山东医药,2017,57(6):54-56.
[15]陈屹,曹优文.NIPPV在稳定期合并慢性呼吸衰竭的COPD患者治疗中对肺功能、动脉血气及生活质量的影响[J].现代医药卫生,2018,34(6):897-899.
[16]吴东岳,吴魏霞,卢竞.布地奈德气雾剂雾化吸入联合无创正压通气对COPD合并Ⅱ型呼吸衰竭患者动脉血气指标改善及肺功能的影响[J].哈尔滨医药,2018,38(1):3-5.
[17]田瑞雪,叶青,侯洪艳,等.慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的血清降钙素原水平的临床研究[J].临床医学研究与实践,2018,3(6):26-28,31.
[18]Gerards M C,Venema G E,Patberg K W,et al.Dapagliflozin for prednisone-induced hyperglycemia in acute exacerbation of chronic obstructive pulmonary disease.[J].Diabetes Obes Metab,2018,20(5):1306-1310.
[19]李小龙.AECOPD患者血清IL-6,TNF-α,G-CSF,CRP,PCT水平及其与病情严重程度的相关性分析[J].临床肺科杂志,2018,23(5):846-849.
[20]张丽丽,薛培丽,邱立志,等.慢性阻塞性肺疾病并发症的临床分析[J].临床急诊杂志,2015,16(2):138-140.
[2]舒利迭.布地奈德福莫特罗粉吸入剂[J].中国呼吸与危重监护杂志,2014,13(5):428-428.
[3]张婷,史菲,酆孟洁.超敏C反应蛋白/白蛋白比值对无创通气治疗AECOPD合并呼吸衰竭患者的预后评估价值[J].广东医学,2018,39(4):533-536.
[4]朱幼鸣,胡辉,曾烨.无创正压通气辅助治疗对COPD合并II型呼吸衰竭患者血气参数、心功能及炎症状态的影响[J].海南医学院学报,2017,23(3):327-330.
[5]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中国医学前沿杂志(电子版),2014,6(2):484-491.
[6]Julu P,Shah M,Monro J A,et al.Carbon dioxide therapy in hypocapnic respiratory failure.[J].Med Hypotheses,2018,110(11):101-104.
[7]Hempel G,Simon P,Salz P,et al.Respiratory Failure:Innovations in Diagnostics and Therapy[J].Anasthesiol Intensivmed Notfallmed Schmerzther,2018,53(2):126-140.
[8]许俊旭,王聪,郝金香.COPD急性加重并发Ⅱ型呼吸衰竭疑诊合并急性肺血栓栓塞症抗凝治疗的临床观察[J].广东医学,2018,39(2):255-258.
[9]Goto T,Hirayama A,Faridi M K,et al.Obesity and Severity of Acute Exacerbation of Chronic Obstructive Pulmonary Disease.[J].Ann Am Thorac Soc,2018,15(2):184-191.
[10]Goto T,Faridi M K,Camargo C A,et al.The association of aspirin use with severity of acute exacerbation of chronic obstructive pulmonary disease:a retrospective cohort study[J].NPJ Prim Care Respir Med,2018,28(1):7-7.
[11]林怀印,张敏,孟肖.细辛脑注射液联合纳络酮治疗慢性肺心病呼吸衰竭的临床研究[J].现代药物与临床,2018,33(4):817-822.
[12]张春美,丁震,裴罛,等.无创机械通气联合经管道雾化吸入布地奈德治疗AECOPD合并Ⅱ型呼吸衰竭的疗效[J].实用医学杂志,2015,11(5):819-820.
[13]周梅芬.机械通气辅助治疗在重症哮喘并发呼吸衰竭急诊抢救中的应用效果[J].世界最新医学信息文摘,2018,18(2):69-69.
[14]陈春芬,徐德祥.滴定呼气灵敏度在AECOPD合并呼吸衰竭患者无创正压通气治疗中的应用[J].山东医药,2017,57(6):54-56.
[15]陈屹,曹优文.NIPPV在稳定期合并慢性呼吸衰竭的COPD患者治疗中对肺功能、动脉血气及生活质量的影响[J].现代医药卫生,2018,34(6):897-899.
[16]吴东岳,吴魏霞,卢竞.布地奈德气雾剂雾化吸入联合无创正压通气对COPD合并Ⅱ型呼吸衰竭患者动脉血气指标改善及肺功能的影响[J].哈尔滨医药,2018,38(1):3-5.
[17]田瑞雪,叶青,侯洪艳,等.慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的血清降钙素原水平的临床研究[J].临床医学研究与实践,2018,3(6):26-28,31.
[18]Gerards M C,Venema G E,Patberg K W,et al.Dapagliflozin for prednisone-induced hyperglycemia in acute exacerbation of chronic obstructive pulmonary disease.[J].Diabetes Obes Metab,2018,20(5):1306-1310.
[19]李小龙.AECOPD患者血清IL-6,TNF-α,G-CSF,CRP,PCT水平及其与病情严重程度的相关性分析[J].临床肺科杂志,2018,23(5):846-849.
[20]张丽丽,薛培丽,邱立志,等.慢性阻塞性肺疾病并发症的临床分析[J].临床急诊杂志,2015,16(2):138-140.