摘要
目的探讨特布他林联合经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)治疗老年慢性阻塞性肺疾病急性加重(AECOPD)伴呼吸衰竭的临床效果。方法以2016年2月至2018年1月在我院老年科接受治疗的130例AECOPD伴呼吸衰竭的病人为研究对象,按随机数字表法将其分为观察组和对照组,每组各65例。对照组给予鼻面罩双水平正压通气治疗;观察组给予HFNC+特布他林。观察2组的临床疗效,治疗前后肺功能指标、血气参数、血清炎性因子水平的变化及不良反应发生情况。结果观察组总有效率为8923%,明显高于对照组的7385%(P<005);治疗后,2组最大呼气流量、用力肺活量、第1秒用力呼气量占预计值百分比、动脉血氧分压、动脉血二氧化碳分压、氧合指数明显优于治疗前,且观察组各指标均显著优于对照组(P<005);治疗后,2组病人肿瘤坏死因子-α及降钙素原水平均明显降低(P<005),且观察组明显低于对照组;观察组不良反应发生率为61%,明显低于对照组的338%(P<005)。结论特布他林联合HFNC治疗老年AECOPD伴呼吸衰竭能够显著降低炎性因子水平,改善血气水平及肺功能,具有良好的耐受性。
Objective To investigate the clinical efficacy of terbutaline combined with high-flownasal cannula oxygen therapy(HFNC) in the treatment of acute exacerbation of chronic obstructivepulmonary disease(AECOPD) complicated with respiratory failure. Methods A total of 130 elderlypatients with AECOPD complicated with respiratory failure in our hospital from February 2016 to January2018 were randomly divided into control group(65 cases) and observation group(65 cases). The patientsin control group were given bilevel positive air pressure, while the patients in observation group weregiven terbutaline combined with HFNC. Clinical efficacy, pulmonary function, blood gas indexes, thelevels of cytokines before and after treatment and the incidence of adverse reactions were observed in bothgroups. Results The effective rate in observation group(89. 23%) was significantly higher than thatin control group(73. 85%)(P<0. 05). After treatment, the levels of peak expiratory flow, forced vitalcapacity, forced expiratory volume in one second, arterial partial pressure of oxygen, arterial partialpressure of carbon dioxide and oxygenation index in both groups were obviously better than those beforetreatment, and the above indicators in observation group were significantly better than those in controlgroup(P<0. 05). After treatment, the levels of TNF-αand procalcitonin in both groups were significantlylower than those before treatment, and were much lower in observation group than those in control group(P<0. 05). The incidence rate of adverse reactions in observation group(6. 1%) was significantly lowerthan that in control group(33. 8%)(P<0. 05). Conclusions Terbutaline combined with HFNC caneffectively decrease the cytokines levels, improve the blood gas levels and lung function, which is well-tolerated.
引文
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