无创正压通气+常规治疗在COPD并Ⅱ型呼吸衰竭患者中的应用价值
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摘要
目的:探讨无创正压通气以及常规治疗对慢性阻塞性肺疾病(COPD)并Ⅱ型呼吸衰竭患者炎症状态、心功能以及血气参数的影响。方法:选取2016年9月-2017年9月本院收治的60例COPD并Ⅱ型呼吸衰竭患者,按照随机数字表法将其分为观察组和对照组,各30例。对照组采取一般常规治疗,观察组在对照组基础上,进行无创正压通气的辅助治疗。连续治疗2周后,比较两组炎症状态(hs-CRP、IL-33、PGE_2、sICAM-1、PCT)、心功能(NTpro-BNP、GDF-15、CysC、Copeptin、APN)以及血气参数(Cl~-、PaCO_2、CO_2CP、pH、PaO_2)。结果:治疗后,观察组血清hs-CRP、IL-33、PGE_2、s ICAM-1、PCT等相关炎症因子水平均低于对照组,差异均有统计学意义(P<0.05);治疗后,观察组血清NTpro-BNP、GDF-15、CysC、Copeptin、APN水平均低于对照组,差异均有统计学意义(P<0.05);治疗后,观察组CI~-、PaCO_2、CO_2CP均低于对照组,pH、PaO_2均高于对照组,差异均有统计学意义(P<0.05)。结论:采用无创正压通气联合常规治疗对于改善COPD并Ⅱ型呼吸衰竭患者的炎症状态、心功能以及血气参数有积极的意义,对于改善整体的治疗有正面意义。
Objective:To analyze the effects of noninvasive positive pressure ventilation and conventional therapy on inflammatory state,cardiac function and blood gas parameters in patients with chronic obstructive pulmonary disease(COPD)and type Ⅱ respiratory failure.Method:A total of 60 COPD patients with type Ⅱ respiratory failure admitted to our hospital from September 2016 to September 2017 were selected.According to the random number table method,they were divided into observation group and control group,30 cases in each group.The control group received conventional therapy,while observation group received noninvasive positive pressure ventilation on the basis of control group.After two weeks of continuous treatment,the inflammatory status(hs-CRP,IL-33,PGE_2,sICAM-1,PCT),cardiac function(NTpro-BNP,GDF-15,CysC,Copeptin,APN)and blood gas parameters(Cl~-,PaCO_2,CO_2,CO_2 CP,pH,PaO_2)between two groups were compared. Result:After treatment,the serum levels of hs-CRP,IL-33,PGE_2,sICAM-1 and PCT in observation group were lower than those of control group,the differences were statistically significant(P<0.05).After treatment,the serum levels of NTpro-BNP,GDF-15,CysC,Copeptin and APN in observation group were lower than those of control group,the differences were statistically significant(P<0.05).After treatment,the levels of Cl~-,PaCO_2 and CO_2 CP in observation group were lower than those of control group,while pH and PaO_2 were higher than those of control group,the differences were statistically significant(P<0.05).Conclusion:Noninvasive positive pressure ventilation combined with conventional therapy has positive significance for improving inflammation,cardiac function and blood gas parameters of COPD patients with type Ⅱ respiratory failure,and for improving the overall treatment.
Objective:To analyze the effects of noninvasive positive pressure ventilation and conventional therapy on inflammatory state,cardiac function and blood gas parameters in patients with chronic obstructive pulmonary disease(COPD)and type Ⅱ respiratory failure.Method:A total of 60 COPD patients with type Ⅱ respiratory failure admitted to our hospital from September 2016 to September 2017 were selected.According to the random number table method,they were divided into observation group and control group,30 cases in each group.The control group received conventional therapy,while observation group received noninvasive positive pressure ventilation on the basis of control group.After two weeks of continuous treatment,the inflammatory status(hs-CRP,IL-33,PGE_2,sICAM-1,PCT),cardiac function(NTpro-BNP,GDF-15,CysC,Copeptin,APN)and blood gas parameters(Cl~-,PaCO_2,CO_2,CO_2 CP,pH,PaO_2)between two groups were compared. Result:After treatment,the serum levels of hs-CRP,IL-33,PGE_2,sICAM-1 and PCT in observation group were lower than those of control group,the differences were statistically significant(P<0.05).After treatment,the serum levels of NTpro-BNP,GDF-15,CysC,Copeptin and APN in observation group were lower than those of control group,the differences were statistically significant(P<0.05).After treatment,the levels of Cl~-,PaCO_2 and CO_2 CP in observation group were lower than those of control group,while pH and PaO_2 were higher than those of control group,the differences were statistically significant(P<0.05).Conclusion:Noninvasive positive pressure ventilation combined with conventional therapy has positive significance for improving inflammation,cardiac function and blood gas parameters of COPD patients with type Ⅱ respiratory failure,and for improving the overall treatment.
引文
[1]吴国顺,宣瑞萍.无创正压通气治疗慢性阻塞性肺病合并呼吸衰竭疗效观察[J].安徽医学,2013,34(12):1800-1801.
[2]狐启贵,刘良丽.益气活血化痰法联合无创辅助通气治疗慢阻肺急性加重期呼吸衰竭[J].中国实验方剂学杂志,2013,19(20):303-306.
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[5]DoubkováM,Karpí?ek M,Mazoch J,et al.Prognostic significance of surfactant protein A,surfactant protein D,Clara cell protein 16,S100 protein,trefoil factor 3,and prostatic secretory protein 94 in idiopathic pulmonary fibrosis,sarcoidosis,and chronic pulmonary obstructive disease[J].Sarcoidosis Vasc Diffuse Lung Dis,2016,33(3):224-234.
[6]吴娟,沙杭.稳定期慢性阻塞性肺疾病患者血清可溶性髓样细胞触发受体-1的检测及临床意义[J].实用医学杂志,2016,32(10):1609-1612.
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[8]老奋坚,舒宗妮,韩俊彦,等.白细胞介素-32在慢性阻塞性肺疾病发病中的研究现状[J].广东医学,2016,37(9):1395-1397.
[9]谢文英,尚立芝,潘晓丽,等.爱罗咳喘宁对慢性阻塞性肺疾病大鼠肺功能血气指标及病理变化的影响[J]中国实验方剂学杂志,2014,20(22):117-120.
[10]张敬浩,武焱旻.无创正压通气治疗时机对慢阻肺合并呼吸衰竭者疗效及骨骼肌泛素-蛋白酶体表达的影响[J].临床肺科杂志,2017,22(8):1463-1467.
[11]吴涛,张华兵,徐文中.鼻面罩无创正压通气联用呼吸兴奋剂治疗慢阻肺呼吸衰竭合并肺性脑病患者的疗效[J].国际医药卫生导报,2017,23(20):3195-3197.
[12]文晓宏.联用无创正压通气术和纳洛酮对合并呼吸衰竭的慢阻肺患者进行治疗的效果研究[J].当代医药论丛,2015,13(21):269-270.
[13]胡中泉.无创正压通气治疗慢阻肺合并呼吸衰竭的临床观察[J].现代诊断与治疗,2016,27(13):2513-2515.
[14]覃超群.无创正压通气治疗慢性阻塞性肺疾病预后分析[J].吉林医药学院学报,2015,36(2):104-105.
[15]王国栋,苏钦峰,张红伟.应用无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的疗效观察[J].中国实用医药,2013,7(35):96-97.
[16]李彩霞,刘建波.无创正压通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭的临床疗效观察[J].世界最新医学信息文摘,2016,16(52):93.
[17]詹昌盛.慢性阻塞性肺疾病稳定期患者生存质量与肺功能的关系[J]深圳中西医结合杂志,2015,25(8):19-20.
[18]秦小雯.无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭疗效预测研究进展[J].内科,2015,10(4):554-556.
[19]谢富连,向志国,朱德山.无创正压通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭的临床疗效观察[J].世界最新医学信息文摘,2017,17(15):55.
[20]雷志坚,冯广弘,刘航.无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的有效性观察[J].中国社区医师,2016,32(11):32-33.
[2]狐启贵,刘良丽.益气活血化痰法联合无创辅助通气治疗慢阻肺急性加重期呼吸衰竭[J].中国实验方剂学杂志,2013,19(20):303-306.
[3]刘长志.无创通气联合噻托溴铵在老年慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭的临床应用[J].中国老年学杂志,2014,34(2):514-515.
[4]Jónsdóttir B,Jaworowski?,San Miguel C,et al.IL-8 predicts early mortality in patients with acute hypercapnic respiratory failure treated with noninvasive positive pressure ventilation[J].BMC Pulm Med,2017,17(1):35.
[5]DoubkováM,Karpí?ek M,Mazoch J,et al.Prognostic significance of surfactant protein A,surfactant protein D,Clara cell protein 16,S100 protein,trefoil factor 3,and prostatic secretory protein 94 in idiopathic pulmonary fibrosis,sarcoidosis,and chronic pulmonary obstructive disease[J].Sarcoidosis Vasc Diffuse Lung Dis,2016,33(3):224-234.
[6]吴娟,沙杭.稳定期慢性阻塞性肺疾病患者血清可溶性髓样细胞触发受体-1的检测及临床意义[J].实用医学杂志,2016,32(10):1609-1612.
[7]Hillas G,Perlikos F,Toumpanakis D,et al.Controlled Mechanical Ventilation Attenuates the Systemic Inflammation of Severe Chronic Obstructive Pulmonary Disease Exacerbations[J].Am J Respir Crit Care Med,2016,193(6):696-698.
[8]老奋坚,舒宗妮,韩俊彦,等.白细胞介素-32在慢性阻塞性肺疾病发病中的研究现状[J].广东医学,2016,37(9):1395-1397.
[9]谢文英,尚立芝,潘晓丽,等.爱罗咳喘宁对慢性阻塞性肺疾病大鼠肺功能血气指标及病理变化的影响[J]中国实验方剂学杂志,2014,20(22):117-120.
[10]张敬浩,武焱旻.无创正压通气治疗时机对慢阻肺合并呼吸衰竭者疗效及骨骼肌泛素-蛋白酶体表达的影响[J].临床肺科杂志,2017,22(8):1463-1467.
[11]吴涛,张华兵,徐文中.鼻面罩无创正压通气联用呼吸兴奋剂治疗慢阻肺呼吸衰竭合并肺性脑病患者的疗效[J].国际医药卫生导报,2017,23(20):3195-3197.
[12]文晓宏.联用无创正压通气术和纳洛酮对合并呼吸衰竭的慢阻肺患者进行治疗的效果研究[J].当代医药论丛,2015,13(21):269-270.
[13]胡中泉.无创正压通气治疗慢阻肺合并呼吸衰竭的临床观察[J].现代诊断与治疗,2016,27(13):2513-2515.
[14]覃超群.无创正压通气治疗慢性阻塞性肺疾病预后分析[J].吉林医药学院学报,2015,36(2):104-105.
[15]王国栋,苏钦峰,张红伟.应用无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的疗效观察[J].中国实用医药,2013,7(35):96-97.
[16]李彩霞,刘建波.无创正压通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭的临床疗效观察[J].世界最新医学信息文摘,2016,16(52):93.
[17]詹昌盛.慢性阻塞性肺疾病稳定期患者生存质量与肺功能的关系[J]深圳中西医结合杂志,2015,25(8):19-20.
[18]秦小雯.无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭疗效预测研究进展[J].内科,2015,10(4):554-556.
[19]谢富连,向志国,朱德山.无创正压通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭的临床疗效观察[J].世界最新医学信息文摘,2017,17(15):55.
[20]雷志坚,冯广弘,刘航.无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的有效性观察[J].中国社区医师,2016,32(11):32-33.