BiPAP无创通气联合特布他林及氨溴索治疗重度慢性阻塞性肺疾病患者的临床效果观察

Clinical effect of BiPAP noninvasive ventilation combined with terbutaline and ambroxol in severe COPD patients

目的观察BiPAP无创通气联合特布他林、氨溴索治疗重度慢性阻塞性肺疾病（COPD）患者的临床效果。方法选取2014年6月—2015年10月在解放军第四七四医院呼吸内科接受治疗的重度COPD患者100例为观察对象,并根据其治疗方式分为2组。对照组（45例）行BiPAP无创通气,观察组（55例）,在无创通气基础上予特布他林、氨溴索治疗。观察2组患者的治疗效果,治疗前后肺功能、血气指标和血清炎性细胞因子水平的差异,记录不良反应的情况。结果观察组治疗的总有效率明显高于对照组（98.2%vs.84.4%,χ^2=6.346,P=0.012）;治疗前2组患者的肺功能指标6分钟步行试验（6MWT）、用力肺活量（FVC）、一秒用力呼气容积（FEV1）、FEV1/FVC、最大呼气中段流量（MMEF）和峰值呼气流速（PEF）以及血气指标PaO2、pH和PaCO2水平差异无统计学意义（P〉0.05）,治疗后,2组患者的肺功能指标和PaO2、pH均较治疗前增高,PaCO2均较治疗前降低,而观察组变化较对照组更为明显（P〈0.05）;治疗前,2组患者的IL-8、IL-17、hs-CRP、TNF-α等指标无明显差别（P〉0.05）,治疗后,2组患者的上述指标均较治疗前下降,且观察组较对照组下降更为明显（P〈0.05）。2组患者均无不良反应发生。结论 BiPAP无创通气联合特布他林、氨溴索对重度COPD患者有较好的治疗效果,可明显改善患者的肺功能和血气水平。

Objective To observe the clinical effect of severe chronic obstructive pulmonary disease（COPD） patients treated by BiPAP noninvasive ventilation combined with terbulaline and ambroxol.Methods From June 2014 to 2015 October,100 patients of severe COPD from PLA 474 hospital were enrolled as object of observation.They divided into noninvasive ventilation group（45 case） and Combined treatment group（55 case）,noninvasive ventilation group treated by BiPAP noninvasive ventilation,Combined treatment group treated by BiPAP noninvasive ventilation combined with terbutaline and ambroxol.Clinical effect by Pulmonary function,blood gas indexes and serum inflammatory cytokines levels before and after treatment,adverse reaction conditions were observed.Results The total effective rate in observation group was significantly higher than the control group（98.2%vs.84.4%,χ^2=6.346,P=0.012）;the indexes of lung function before treatment in2 groups of 6 minute walk test（6MWT）,forced vital capacity（FVC）,forced expiratory volume in one second（FEV1）,FEV1/FVC,maximal mid-expiratory flow（MMEF） and the peak expiratory How rate（PEF） had no statistical significance of PaO2,pH and blood gas index and PaCO,level difference（P〉0.05）.Alter treatnienl,the 2 groups of patients with lung function index and PaO2 and pH were higher than that before treatment,PaCO2 was lower than before treatment,and the observation group changed more obviously than that in control group（P〈0.05）;before treatment,no significant difference between the 2 groups of patients with IL-8,1L-17,hs-CRP,TNF-α index（P〉0.05）.After treatment,the indexes of the 2groups of patients were lower than that before treatment,and the observation group decreased more obvious than the control group（P〈0.05）.No adverse reactions occurred in 2 groups of patients.Conclusion BiPAP noninvasive ventilation combined with terbutaline and ambroxol has better therapeutic effect in the treatment of severe COPD patients,can significantly improve the patients lung function and blood gas levels.