特布他林联合经鼻高流量氧疗治疗老年慢性阻塞性肺疾病急性加重伴呼吸衰竭的临床效果
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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.
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
[1]任成山,白莉,钱桂生.慢性阻塞性肺疾病合并肺癌临床特征及新理念[J].中华肺部疾病杂志:电子版, 2015,8(2):137-142.
[2]莫必华,刘艳秀,邓石荣,等.重度AECOPD有创机械通气患者甲状腺激素及皮质醇变化与预后的临床观察[J].中国急救医学, 2015, 35(10):908-911.
[3]钱利华. BIPAP无创呼吸机治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭疗效观察[J].临床肺科杂志, 2013, 18(12):2243-2244.
[4]郭东霖,王宇,张玉想.经鼻高流量氧疗在慢性阻塞性肺疾病中的研究进展[J].医学综述, 2018, 24(12):2284-2388.
[5]台娜,马小玉,李鹏飞.糖皮质激素联合特布他林在治疗慢阻肺患者中的效果分析[J].临床研究, 2018, 26(3):54-55.
[6]慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志, 2014, 34(1):1-11.
[7]中华医学会呼吸病学分会呼吸生理与重症监护学组.无创正压通气临床应用专家共识[C]. 301呼吸危重症高峰论坛, 2009.
[8]悦云.纤维支气管镜对机械通气治疗COPD并呼吸衰竭的效果及并发症的影响[J].中国急救医学, 2015, 35(4):355-358.
[9]付中帅,崔青荣,周庆伟.慢性阻塞性肺疾病中西医结合治疗的概括[J].中医临床研究, 2015, 34(7):142-145.
[10]王莉,赵洪文.低氧性呼吸系统疾病氧疗的新选择:湿化高流量鼻导管吸氧[J].中国实用内科杂志, 2017, 37(11):1013-1016.
[11] Moller W, Celik G, Feng S,et al. Nasal high flow clears anatomical dead space in upper airways models[J]. J Appl Physiol(1985), 2015, 118(12):1525-1532.
[12]杨毅,刘楠,侯晓彤,等. HFNC与NPPV对于心外科术后低氧血症患者的临床研究[J].首都医科大学学报,2016, 37(5):664-671.
[13] Simpson AJ, Bood JR, Anderson SD, et al. A standard,single dose of inhaled terbutaline attenuates hyperpnea-induced bronchoconstriction and mast cell activation in athletes[J]. J Appl Physiol(1985), 2016, 120(9):1011-1017.
[14]吴苏华,李远华,赖志君. BIPAP联合特布他林雾化吸入治疗COPD伴呼吸衰竭患者临床疗效分析[J].内科,2015, 10(3):312-314.
[15]李红建,王波,张安珍. COPD稳定期患者血清IL-6、TNF-α、MMP-9水平与BODE指数的相关性研究[J].国际呼吸杂志, 2016, 36(16):1221-1224.
[16]牛艳慧,高勇,王鑫,等.降钙素原水平与C反应蛋白对重症慢性阻塞性肺疾病患者的预测价值[J].临床肺科杂志, 2015, 20(3):530-535.
[17]靳情,牛志立,李艳.血清降钙素原在慢性阻塞性肺疾病不同病程中的诊断价值[J].职业与健康, 2016, 32(13):1777-1781.
[18]李晓佳,张俊林,金雪梅,等.糖皮质激素联合特布他林治疗慢性阻塞性肺疾病急性加重期对肺功能及预后的影响[J].国际呼吸杂志, 2016, 36(5):346-349.
[19]左声勇.糖皮质激素联合特布他林治疗慢阻肺急性加重期40例用药效果初评[J].中外医学研究, 2016, 14(9):133-134.
[2]莫必华,刘艳秀,邓石荣,等.重度AECOPD有创机械通气患者甲状腺激素及皮质醇变化与预后的临床观察[J].中国急救医学, 2015, 35(10):908-911.
[3]钱利华. BIPAP无创呼吸机治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭疗效观察[J].临床肺科杂志, 2013, 18(12):2243-2244.
[4]郭东霖,王宇,张玉想.经鼻高流量氧疗在慢性阻塞性肺疾病中的研究进展[J].医学综述, 2018, 24(12):2284-2388.
[5]台娜,马小玉,李鹏飞.糖皮质激素联合特布他林在治疗慢阻肺患者中的效果分析[J].临床研究, 2018, 26(3):54-55.
[6]慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志, 2014, 34(1):1-11.
[7]中华医学会呼吸病学分会呼吸生理与重症监护学组.无创正压通气临床应用专家共识[C]. 301呼吸危重症高峰论坛, 2009.
[8]悦云.纤维支气管镜对机械通气治疗COPD并呼吸衰竭的效果及并发症的影响[J].中国急救医学, 2015, 35(4):355-358.
[9]付中帅,崔青荣,周庆伟.慢性阻塞性肺疾病中西医结合治疗的概括[J].中医临床研究, 2015, 34(7):142-145.
[10]王莉,赵洪文.低氧性呼吸系统疾病氧疗的新选择:湿化高流量鼻导管吸氧[J].中国实用内科杂志, 2017, 37(11):1013-1016.
[11] Moller W, Celik G, Feng S,et al. Nasal high flow clears anatomical dead space in upper airways models[J]. J Appl Physiol(1985), 2015, 118(12):1525-1532.
[12]杨毅,刘楠,侯晓彤,等. HFNC与NPPV对于心外科术后低氧血症患者的临床研究[J].首都医科大学学报,2016, 37(5):664-671.
[13] Simpson AJ, Bood JR, Anderson SD, et al. A standard,single dose of inhaled terbutaline attenuates hyperpnea-induced bronchoconstriction and mast cell activation in athletes[J]. J Appl Physiol(1985), 2016, 120(9):1011-1017.
[14]吴苏华,李远华,赖志君. BIPAP联合特布他林雾化吸入治疗COPD伴呼吸衰竭患者临床疗效分析[J].内科,2015, 10(3):312-314.
[15]李红建,王波,张安珍. COPD稳定期患者血清IL-6、TNF-α、MMP-9水平与BODE指数的相关性研究[J].国际呼吸杂志, 2016, 36(16):1221-1224.
[16]牛艳慧,高勇,王鑫,等.降钙素原水平与C反应蛋白对重症慢性阻塞性肺疾病患者的预测价值[J].临床肺科杂志, 2015, 20(3):530-535.
[17]靳情,牛志立,李艳.血清降钙素原在慢性阻塞性肺疾病不同病程中的诊断价值[J].职业与健康, 2016, 32(13):1777-1781.
[18]李晓佳,张俊林,金雪梅,等.糖皮质激素联合特布他林治疗慢性阻塞性肺疾病急性加重期对肺功能及预后的影响[J].国际呼吸杂志, 2016, 36(5):346-349.
[19]左声勇.糖皮质激素联合特布他林治疗慢阻肺急性加重期40例用药效果初评[J].中外医学研究, 2016, 14(9):133-134.