无创正压通气联合纤维支气管镜肺泡灌洗对肺部感染患者临床疗效及基质金属蛋白酶9、白细胞表面Toll样受体4水平的影响
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摘要
目的探讨无创正压通气(NIPPV)联合纤维支气管镜肺泡灌洗对肺部感染患者临床疗效及基质金属蛋白酶9(MMP-9)、白细胞表面Toll样受体4(TLR-4)水平的影响。方法选取2013年1月—2017年1月百色市人民医院收治的肺部感染患者164例,采用随机数字表法分为对照组和观察组,每组82例。对照组患者在常规治疗基础上行NIPPV,观察组患者在对照组基础上行纤维支气管镜肺泡灌洗治疗;两组患者均连续治疗2周。比较两组患者临床疗效,治疗前后呼吸频率、心率、肺功能指标[包括每分钟最大通气量(MMV)、功能残气量(FRC)、第1秒用力呼气容积(FEV_1)、每分钟最大呼气流量(MMEF)及肺总量(TLC)]、动脉血气分析指标[包括动脉血氧饱和度(SpO_2)、动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)]及MMP-9、白细胞表面TLR-4水平,并比较两组患者随访1个月期间不良反应发生率、再住院率、心脏事件及并发症发生率。结果 (1)观察组患者临床疗效优于对照组(P<0.05)。(2)治疗前两组患者呼吸频率及心率比较,差异无统计学意义(P>0.05);治疗后观察组患者呼吸频率及心率低于对照组(P<0.05)。(3)治疗前两组患者MMV、FRC、FEV1、MMEF、TLC比较,差异无统计学意义(P>0.05);治疗后观察组患者MMV、FRC、FEV1、MMEF、TLC大于对照组(P<0.05)。(4)治疗前两组患者SpO_2、PaCO_2、PaO_2比较,差异无统计学意义(P>0.05);治疗后观察组患者SpO_2、PaO_2高于对照组,PaCO_2低于对照组(P<0.05)。(5)治疗前两组患者MMP-9、白细胞表面TLR-4水平比较,差异无统计学意义(P>0.05);治疗后观察组患者MMP-9、白细胞表面TLR-4水平低于对照组(P<0.05)。(6)随访期间观察组患者不良反应发生率、再住院率、心脏事件发生率、并发症发生率低于对照组(P<0.05)。结论 NIPPV联合纤维支气管镜肺泡灌洗可有效提高肺部感染患者临床疗效,改善患者肺功能及氧合状态,降低MMP-9、白细胞表面TLR-4水平,且安全性较高。
Objective To investigate the impact of non-invasive positive pressure ventilation(NIPPV)combined with fibrobronchoscopic alveolar lavage on clinical effect,MMP-9 and leukocyte surface TLR-4 in patients with pulmonary infection. Methods A total of 164 patients with pulmonary infection were selected in the People's Hospital of Baise from January 2013 to January 2017,and they were divided into control group and observation group according to random number table method,with 82 cases in each group. Patients in control group received NIPPV based on routine treatment,while patients in observation group received fibrobronchoscopic alveolar lavage based on that of control group;both groups continuously treated for 2 weeks. Clinical effect,respiratory rate,heart rate,index of pulmonary function(including MMV,FRC,FEV1,MMEF and TLC),arterial blood-gas analysis results(including SpO2,PaCO2 and PaO2),MMP-9 and leukocyte surface TLR-4 before and after treatment were compared between the two groups;incidence of adverse reactions,cardiac events and complications,and re-hospitalization rate during the 1-month follow-up were compared,too. Results(1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)No statistically significant difference of respiratory rate or heart rate was found between the two groups before treatment(P>0.05),while respiratory rate and heart rate in observation group were statistically significantly lower than those in control group after treatment(P<0.05).(3)No statistically significant difference of MMV,FRC,FEV1,MMEF or TLC was found between the two groups before treatment(P>0.05),while MMV,FRC,FEV1,MMEF and TLC in observation group were statistically significantly larger than those in control group after treatment(P<0.05).(4)No statistically significant difference of SpO2,PaCO2 or PaO2 was found between the two groups before treatment(P>0.05);after treatment,SpO2 and PaO2 in observation group were statistically significantly higher than those in control group,while PaCO2 in observation group was statistically significantly lower than that in control group(P<0.05).(5)No statistically significant difference of MMP-9 or leukocyte surface TLR-4 was found between the two groups before treatment(P>0.05),while MMP-9 and leukocyte surface TLR-4 in observation group were statistically significantly lower than those in control group after treatment(P<0.05).(6)Incidence of adverse reactions,cardiac events and complications,and re-hospitalization rate in observation group were statistically significantly lower than those in control group during follow-up(P<0.05). Conclusion In patients with pulmonary infection,NIPPV combined with fibrobronchoscopic alveolar lavage can effectively improve the clinical effect,pulmonary function and oxygenation state,reduce the MMP-9 and leukocyte surface TLR-4,with relatively high safety.
Objective To investigate the impact of non-invasive positive pressure ventilation(NIPPV)combined with fibrobronchoscopic alveolar lavage on clinical effect,MMP-9 and leukocyte surface TLR-4 in patients with pulmonary infection. Methods A total of 164 patients with pulmonary infection were selected in the People's Hospital of Baise from January 2013 to January 2017,and they were divided into control group and observation group according to random number table method,with 82 cases in each group. Patients in control group received NIPPV based on routine treatment,while patients in observation group received fibrobronchoscopic alveolar lavage based on that of control group;both groups continuously treated for 2 weeks. Clinical effect,respiratory rate,heart rate,index of pulmonary function(including MMV,FRC,FEV1,MMEF and TLC),arterial blood-gas analysis results(including SpO2,PaCO2 and PaO2),MMP-9 and leukocyte surface TLR-4 before and after treatment were compared between the two groups;incidence of adverse reactions,cardiac events and complications,and re-hospitalization rate during the 1-month follow-up were compared,too. Results(1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)No statistically significant difference of respiratory rate or heart rate was found between the two groups before treatment(P>0.05),while respiratory rate and heart rate in observation group were statistically significantly lower than those in control group after treatment(P<0.05).(3)No statistically significant difference of MMV,FRC,FEV1,MMEF or TLC was found between the two groups before treatment(P>0.05),while MMV,FRC,FEV1,MMEF and TLC in observation group were statistically significantly larger than those in control group after treatment(P<0.05).(4)No statistically significant difference of SpO2,PaCO2 or PaO2 was found between the two groups before treatment(P>0.05);after treatment,SpO2 and PaO2 in observation group were statistically significantly higher than those in control group,while PaCO2 in observation group was statistically significantly lower than that in control group(P<0.05).(5)No statistically significant difference of MMP-9 or leukocyte surface TLR-4 was found between the two groups before treatment(P>0.05),while MMP-9 and leukocyte surface TLR-4 in observation group were statistically significantly lower than those in control group after treatment(P<0.05).(6)Incidence of adverse reactions,cardiac events and complications,and re-hospitalization rate in observation group were statistically significantly lower than those in control group during follow-up(P<0.05). Conclusion In patients with pulmonary infection,NIPPV combined with fibrobronchoscopic alveolar lavage can effectively improve the clinical effect,pulmonary function and oxygenation state,reduce the MMP-9 and leukocyte surface TLR-4,with relatively high safety.
引文
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[15]ZHONG K.Curcumin Mediates a Protective Effect Via TLR-4/NF-κB Signaling Pathway in Rat Model of Severe Acute Pancreatitis[J].Cell Biochem Biophys,2015,73(1):175-180.DOI:10.1007/s12013-015-0664-y.
[16]丛金鹏,郝文嘉,于文成.MMP-9与TIMP-1及其在慢性阻塞性肺疾病中的作用[J].青岛大学医学院学报,2015,10(2):241-243,246.DOI:10.13361/j.qdyxy.201502040.
[17]LI Y T,WANG Y C,LEE H L,et al.Elevated Plasma Matrix Metalloproteinase-9 and Its Correlations with Severity of Disease in Patients with Ventilator-Associated Pneumonia[J].Int J Med Sci,2016,13(8):638-645.DOI:10.7150/ijms.16187.
[2]TAGAMI T,MATSUI H,HORIGUCHI H,et al.Recombinant human soluble thrombomodulin and mortality in severe pneumonia patientswithsepsis-associateddisseminatedintravascular coagulation:an observational nationwide study[J].J Thromb Haemost,2015,13(1):31-40.DOI:10.1111/jth.12786.
[3]PENG Y,XIE L X.Electronic Bronchoscopy During Noninvasive Pressure Ventilation via Own Mask Processing in Severe Pneumonia[J].Chest,2016,149(4):A157.DOI:10.1016/j.chest.2016.02.163.
[4]MURIEL A,PE?UELAS O,FRUTOS-VIVAR F,et al.Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome:a marginal structural model causal analysis[J].Intensive Care Medicine,2015,41(9):1586-1600.DOI:10.1007/s00134-015-3854-6.
[5]LEUNG S S Y,PARUMASIVAM T,GAO F G,et al.Production of Inhalation Phage Powders Using Spray Freeze Drying and Spray Drying Techniques for Treatment of Respiratory Infections[J].Pharm Res,2016,33(6):1486-1496.DOI:10.1007/s11095-016-1892-6.
[6]BARTLETT J G,BREIMAN R F,MANDELL L A,et al.Community-acquiredpneumoniainadults:guidelinesfor management.The Infectious Diseases Society of America[J].Clin Infect Dis,1998,26(4):811-838.
[7]TORRES A,SIBILA O,FERRER M,et al.Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response:a randomized clinical trial[J].JAMA,2015,313(7):677-679.DOI:10.1001/jama.2015.88.
[8]EOM J S,SONG W J,YOO H,et al.Chronic obstructive pulmonary disease severity is associated with severe pneumonia[J].Ann Thorac Med,2015,10(2):105-111.DOI:10.4103/1817-1737.151441.
[9]XIAO B,WANGM,HUX,etal.Antibiotic de-escalation principle in elderly patients with chronic obstructive pulmonary disease complicated with severe pneumonia[J].Exp Ther Med,2017,13(4):1485-1489.DOI:10.3892/etm.2017.4135.
[10]HSIEH Y C,CHI H,CHANG K Y,et al.Increase in fitness of Streptococcus pneumoniae is associated with the severity of necrotizing pneumonia[J].Pediatr Infect Dis J,2015,34(5):499-501.DOI:10.1097/INF.0000000000000631.
[11]GURGUN A,NESIL I,EKREN P K,et al.Is It Possible to Predict the Failure of Noninvasive Mechanical Ventilation for Acute Respiratory Failure Due to Pneumonia?[J].Chest,2015,148(4):121A.DOI:10.1378/chest.2255607.
[12]SANZ F,DEAN N,DICKERSON J,et al.Accuracy of PaO2/FiO2calculated from SpO2 for severity assessment in ED patients with pneumonia[J].Respirology,2015,20(5):813-818.DOI:10.1111/resp.12560.
[13]KONNOS,TANIGUCHIN,MAKITAH,etal.Distinct Phenotypes of Cigarette Smokers Identified by Cluster Analysis of Patients with Severe Asthma[J].Ann Am Thorac Soc,2015,12(12):1771-1780.DOI:10.1513/AnnalsATS.201507-407OC.
[14]MU?OZ-WOLF N,RIAL A,FOUGERON D,et al.Sublingual flagellin protects against acute pneumococcal pneumonia in a TLR5-dependent and NLRC4-independent fashion[J].Future Microbiol,2016,11(9):1167-1177.DOI:10.2217/fmb-2016-0045.
[15]ZHONG K.Curcumin Mediates a Protective Effect Via TLR-4/NF-κB Signaling Pathway in Rat Model of Severe Acute Pancreatitis[J].Cell Biochem Biophys,2015,73(1):175-180.DOI:10.1007/s12013-015-0664-y.
[16]丛金鹏,郝文嘉,于文成.MMP-9与TIMP-1及其在慢性阻塞性肺疾病中的作用[J].青岛大学医学院学报,2015,10(2):241-243,246.DOI:10.13361/j.qdyxy.201502040.
[17]LI Y T,WANG Y C,LEE H L,et al.Elevated Plasma Matrix Metalloproteinase-9 and Its Correlations with Severity of Disease in Patients with Ventilator-Associated Pneumonia[J].Int J Med Sci,2016,13(8):638-645.DOI:10.7150/ijms.16187.