雾化吸入碳酸氢液对慢性阻塞性肺疾病急性加重患者呼出气中TNF-α的影响

The effect of the jet nebulization treatments with sodium bicarbonate solution to the TNF-α of the EBC in the patients of AECOPD

目的观察雾化吸入碳酸氢钠溶液对慢性阻塞性肺疾病急性加重(AECOPD)患者呼出气冷凝液(EBC)中肿瘤坏死因子(TNF)-α的影响。方法以2008年10月至2009年5月在昆明总医院呼吸科住院的64例重度AECOPD患者为实验对象,随机分成实验组和对照组。对照组用抗感染、祛痰、常规雾化等治疗;实验组在对照组的基础上加用雾化吸入碳酸氢钠溶液治疗,疗程均为1周。以治疗前后EBC中pH、TNF-α的浓度及肺功能为观察指标。结果 (1)实验组治疗后pH(7.45±0.29)比治疗前明显升高(7.10±0.50,P=0.005),而对照组在治疗后pH也有所升高,但与治疗前比较差异无统计学意义(P=0.06);(2)两组患者治疗后TNF-α的浓度均降低,且与治疗前比较均有统计学差异(对照组:36.87±3.78对29.16±6.17;实验组:37.46±4.28对24.30±2.79,P<0.01),但两组治疗前后差值的统计比较,实验组差异更显著。(3)两组患者的一秒用力呼气量/用力肺活量(FEV1/FVC)、一秒用力呼气量(FEV1)%预计值在治疗后的变化均无统计学意义(P>0.05)。结论雾化碳酸氢钠溶液可明显减轻AECOPD患者气道酸化的程度,降低其EBC中TNF-α的浓度。

Objective To observe The effect of the jet nebulization treatments with sodium bicarbonate solution to the TNF-α of the EBC in the patients of AECOPD. Methods 64 patients with AECOPD in the Kunming General Hospital of Chengdu Military Command were recruited. The subjects were divided randomly into the experimental group and the control group. The control group treated with conventional anti-infection, eliminating phlegm and atomization, while the experimental group plused atomization inhalation sodium bicarbonate for one week. The changes of the lung function, the tumor necrosis factor-α and the pH. values of the EBC will be observed before and after treatment. Results （ 1 ） higher pH values was observed after treatment in the experimental group compared to the control group, and the differences of The pH was statistical significance before and after treatment （the experimental group ：7. 10 ± 0. 502 vs 7. 45± 0. 29, P = 0. 005 ）. （2）lower the tumor necrosis factor-or of the EBC was observed either in the experimental subjects or in the control subjects, there were statistical significance for them before and after treatment（ the control subjects ：36. 87 ± 3.78 vs 29. 16 ± 6. 17;the experimental subjects： 37. 46 ±4. 28 vs 24. 30 ± 2. 79 ,P 〈 0. 01 ）. But there was more significant difference in the experimental patients compared to the control patients （ the experimental subjects = 10. 7 ng/L, the control subjects = 5. 2 ng/L）. （ 3 ） There was not statistical significance in the lung function（ FEV1/FVC, FEV1 % ）before and after treatment either in the experimental group or in the control group（ P 〉 0. 05 ）. Conclusion These findings suggest that Atomization inhalation sodium bicarbonate solution can decrease the acidifying degree of the airway and low the TNF-α of the EBC in the patients of AECOPD.