阿奇霉素联合BiPAP无创呼吸机治疗慢性阻塞性肺疾病合并肺源性心脏病临床效果观察
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摘要
目的探讨阿奇霉素联合BiPAP无创呼吸机治疗慢性阻塞性肺疾病合并肺源性心脏病的临床效果。方法选取凉山彝族自治州第一人民医院自2016年5月至2017年12月收治的80例慢性阻塞性肺疾病合并肺源性心脏病患者为研究对象,将患者随机分入A组和B组,每组各40例。A组患者在常规治疗基础上应用阿奇霉素,B组患者在A组基础上接受BiPAP无创呼吸机治疗。比较两组患者的治疗有效率、急性加重次数、肺功能相关指标、血气相关指标、脑尿钠肽水平及不良反应发生率。结果治疗后,A组有效率为80.0%(32/40),B组有效率为95.0%(38/40),差异有统计学意义(P<0.05)。B组急性加重次数为(2.26±0.36)次,少于A组的(3.17±0.41)次,差异有统计学意义(P<0.05)。两组患者治疗3、6个月后,B组的第一秒钟用力肺活量占预计值百分比、第一秒钟用力肺活量占用力肺活量比值、最大呼气峰流速均高于A组,差异有统计学意义(P<0.05)。治疗后,两组患者的氧分压、血氧饱和度均高于治疗前,且B组高于A组,差异有统计学意义(P<0.05);两组患者的二氧化碳分压均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。治疗6个月后,B组脑尿钠肽水平明显低于A组,差异有统计学意义(P<0.05);与治疗前比较,A组和B组治疗6个月后的脑尿钠肽水平均明显降低,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论阿奇霉素联合BiPAP无创呼吸机治疗慢性阻塞性肺疾病合并肺源性心脏病临床效果显著,可改善患者肺功能,缓解心力衰竭症状。
Objective To investigate the effect of azithromycin combined with BiPAP noninvasive ventilator on chronic obstructive pulmonary disease(COPD) with corpulmonale and the level of brain natriuretic peptide(BNP).Methods A retrospective study was performed on 80 cases of patients with COPD and corpulmonale who were admitted from May 2016 to December 2017.Patients were randomly divided into the Group A and Group B,with 40 cases in each group.Patients in the Group A were treated with azithromycin on the basis of conventional treatment,and the others in Group B were treated with BiPAP non-invasive ventilator on the basis of Group A.The treatment efficiency,times of acute exacerbation,lung function related indicators,blood gas related indicators,BNP level and the incidence of adverse reactions were compared between the two groups.Results After treatment,the effective rate was 80.0%(32/40) in Group A and 95.0%(38/40) in Group B,and the difference was statistically significant(P<0.05).The number of acute exacerbations in Group B was(2.26±0.36),less than that(3.17±0.41)in Group A(P<0.05).After treatment for 3 and 6 months,the percentage of forced vital capacity in the first second,the ratio of forced vital capacity to forced vital capacity in the first second and the maximum peak expiratory flow rate in Group B were all higher than those in Group A(P<0.05).After treatment,oxygen partial pressure and blood oxygen saturation of the two groups were higher than that before treatment,and those of Group B was higher than of Group A(P<0.05).PaCO_2 of patients in both groups was lower than that before treatment,and that in Group B was lower than that in Group A(P<0.05).After 6 months of treatment,the level of BNP in Group B was significantly lower than that in Group A(P<0.05).Compared with before treatment,the level of BNP in Group A and Group B was significantly reduced after 6 months of treatment(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Azithromycin combined with BiPAP non-invasive ventilator has a significant clinical effect in the treatment of COPD combined with corpulmonale,which can improve the pulmonary function of patients and alleviate the symptoms of heart failure.
Objective To investigate the effect of azithromycin combined with BiPAP noninvasive ventilator on chronic obstructive pulmonary disease(COPD) with corpulmonale and the level of brain natriuretic peptide(BNP).Methods A retrospective study was performed on 80 cases of patients with COPD and corpulmonale who were admitted from May 2016 to December 2017.Patients were randomly divided into the Group A and Group B,with 40 cases in each group.Patients in the Group A were treated with azithromycin on the basis of conventional treatment,and the others in Group B were treated with BiPAP non-invasive ventilator on the basis of Group A.The treatment efficiency,times of acute exacerbation,lung function related indicators,blood gas related indicators,BNP level and the incidence of adverse reactions were compared between the two groups.Results After treatment,the effective rate was 80.0%(32/40) in Group A and 95.0%(38/40) in Group B,and the difference was statistically significant(P<0.05).The number of acute exacerbations in Group B was(2.26±0.36),less than that(3.17±0.41)in Group A(P<0.05).After treatment for 3 and 6 months,the percentage of forced vital capacity in the first second,the ratio of forced vital capacity to forced vital capacity in the first second and the maximum peak expiratory flow rate in Group B were all higher than those in Group A(P<0.05).After treatment,oxygen partial pressure and blood oxygen saturation of the two groups were higher than that before treatment,and those of Group B was higher than of Group A(P<0.05).PaCO_2 of patients in both groups was lower than that before treatment,and that in Group B was lower than that in Group A(P<0.05).After 6 months of treatment,the level of BNP in Group B was significantly lower than that in Group A(P<0.05).Compared with before treatment,the level of BNP in Group A and Group B was significantly reduced after 6 months of treatment(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Azithromycin combined with BiPAP non-invasive ventilator has a significant clinical effect in the treatment of COPD combined with corpulmonale,which can improve the pulmonary function of patients and alleviate the symptoms of heart failure.
引文
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[10] 胡克增,陈汉才,陈辉,等.阿奇霉素联合头孢类药物在慢性阻塞性肺疾病急性加重期抗感染治疗中的疗效[J].中华医院感染学杂志,2018,28(3):360-363.
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[12] 胡斯明,徐晓,叶辛幸.BiPAP无创辅助通气治疗老年慢性阻塞性肺疾病患者急性加重期合并急性左心衰的临床疗效[J].中国老年学杂志,2016,36(2):379-381.
[13] 丁晓英,李雯.舒利迭联合无创通气治疗老年慢性阻塞性肺疾病呼吸衰竭的疗效[J].中国老年学杂志,2015,35(10):2823-2825.
[14] 杜强,朱成华,沈立,等.慢性阻塞性肺疾病患者SIRT1表达与氧化应激的相关性研究[J].临床肺科杂志,2016,21(7):1213-1215.
[2] Brightling CE.Chronic obstructive pulmonary disease phenotypes,biomarkers,and prognostic indicators[J].Allergy Asthma Proc,2016,37(6):432.
[3] 刘长志,石瑩心,朱光发.无创正压通气治疗不同病因所致急性呼吸衰竭的疗效与安全性研究[J].心肺血管病杂志,2017,36(2):96-101.
[4] Jia Z,Feng Z,Tian R,et al.Thymosin α 1 plus routine treatment inhibit inflammatory reaction and improve the quality of life in AECOPD patients[J].Immunopharmacol Immunotoxicol,2015,37(4):388-392.
[5] 武红莉,田瑞雪,宁兰丁,等.慢性阻塞性肺疾病患者肺部感染的影响因素分析及血清炎症因子水平变化分析[J].中华医院感染学杂志,2018,28(1):25-28.
[6] Akkafa F,Halil AI,Erkus ME,et al.Reduced SIRT1 expression correlates with enhanced oxidative stress in compensated and decompensated heart failure[J].Redox Biology,2015,6:169-173.
[7] 唐海成,柏宏坚,姜永前,等.慢性阻塞性肺疾病急性加重期患者血清B型利钠肽浓度与CAT评分的相关性研究[J].心肺血管病杂志,2017,36(4):263-265.
[8] 韩利,张筠,张铁栓.长期小剂量阿奇霉素联合布地奈德/福莫特罗治疗Ⅲ、Ⅳ级COPD稳定期患者的疗效[J].实用医学杂志,2016,32(17):2918-2920.
[9] 吴家辉,刘光明,吴轶赟,等.糖皮质激素治疗重症慢性阻塞性肺病合并糖尿病30例临床观察[J].中国民族民间医药,2016,25(4):88-89.
[10] 胡克增,陈汉才,陈辉,等.阿奇霉素联合头孢类药物在慢性阻塞性肺疾病急性加重期抗感染治疗中的疗效[J].中华医院感染学杂志,2018,28(3):360-363.
[11] Hodge S,Hodge G,Holmes M,et al.Increased CD8 T-cell granzyme B in COPD is suppressed by treatment with low-dose azithromycin[J].Respirology,2015,20(1):95-100.
[12] 胡斯明,徐晓,叶辛幸.BiPAP无创辅助通气治疗老年慢性阻塞性肺疾病患者急性加重期合并急性左心衰的临床疗效[J].中国老年学杂志,2016,36(2):379-381.
[13] 丁晓英,李雯.舒利迭联合无创通气治疗老年慢性阻塞性肺疾病呼吸衰竭的疗效[J].中国老年学杂志,2015,35(10):2823-2825.
[14] 杜强,朱成华,沈立,等.慢性阻塞性肺疾病患者SIRT1表达与氧化应激的相关性研究[J].临床肺科杂志,2016,21(7):1213-1215.