沙美特罗替卡松粉吸入剂联合无创通气对COPD合并老年呼吸衰竭患者血流动力学与肾功能指标的影响

Influence of Salmeterol Xinafoate and Fluticasone Propionate Powder for Inhalation Combined with Noninvasive Ventilation on Hemodynamics and Renal Function among Chronic Obstructive Pulmonary Disease Complicated with Geriatric Respiratory Failure

目的探讨沙美特罗替卡松粉吸入剂联合无创通气治疗慢性阻塞性肺疾病(COPD)合并老年呼吸衰竭的效果,及其对肾血流动力学和肾功能指标的影响。方法将2013年6月至2015年6月鄂州市中心医院收治的86例COPD合并老年呼吸衰竭患者采用随机数字法分为无创呼吸机组,各43例。其中无创呼吸机组采用常规治疗联合无创通气治疗,联合治疗组患者则在无创呼吸机组的基础上加用沙美特罗替卡松粉吸入剂联合治疗(每日2次,每次1喷)。比较两组患者的疗效以及治疗前后患者血流动力学、肾功能指标的变化情况。结果联合治疗组的总有效率以及疗效显著高于无创呼吸机组[93.0%(40/43)比69.8%(30/43)](P<0.05)。治疗后,两组患者阻力指数较治疗前降低、舒张末期血流速度以及收缩期血流峰值速度较治疗前提高,且联合治疗组阻力指数较无创呼吸机组更低[(0.66±0.08)比(0.69±0.05)],舒张末期血流速度以及收缩期血流峰值速度较无创呼吸机组更高[(13.1±1.8)cm/s比(12.0±1.8)cm/s、(45.7±7.0)cm/s比(42.3±8.1)cm/s](P<0.05);两组的尿素氮以及血肌酐水平治疗前后以及组间比较,差异均无统计学意义(P>0.05)。结论沙美特罗替卡松粉吸入剂联合无创通气能够显著改善COPD合并老年呼吸衰竭患者的肺部功能,且在不损害患者肾功能的前提下,调节患者肾脏的血流参数,有效改善预后。

Objective To investigate the curative effect of salmeterol xinafoate and fluticasone propionate powder for inhalation combined with noninvasive ventilation for treatment chronic obstructive pulmonary disease （COPD） complicated with geriatric respiratory failure, and its influence on hemodynamics and renal function indexes. Methods A total of 86 cases of COPD complicated with geriatric respiratory failure admitted to Ezhou Central Hospital from Jun. 2013 to Jun. 2015 were selected as objects and then divided into a combined treatment group and a noninvasive ventilation group by ran- dom digits table,with 43 cases in each group. The noninvasive ventilator group received routine therapy and noninvasive ventilator treatment, while the combined treatment group received salmeterol xinafoate and fluticasone propionate powder for inhalation（twice a day, 1 spray each time） on the basis of the noninvasive ventilation group＇s regimen. The hemodynamics, renal function indexes and clinical effect of the two groups were compared. Results Compared with the noninvasive ventila- tor group, the curative effect and total effective rate 6f the combined treatment group was significantly higher[ 93.0% （40/ 43 ） vs 69.8% （ 30/43 ） ] （ P 〈 0.05 ）. After treatment, the resistance index of the two groups were lower, end-diastolic blood flow velocity （Vd） and systolic blood flow peak velocity （Vs） were higher, and the resistance index of the combined treatment group was lower than that of the noninvasive ventilator group [ （ 0.66 ± 0. 08 ） vs （ 0.69 ± 0. 05 ） ], Vd and Vs were higher than those of the noninvasive ventilator group[ （ 13.1 ± 1.8） cm/s vs （ 12.0 ±1.8） cm/s, （45.7 ± 7.0） cm/s vs （42.3 ± 8.1 ） cm/s ] （ P 〈 0.05 ）. The levels of urea nitrogen and serum creatinine of the two groups, before and after treatment, had no statistically significant differences （ P 〉 0. 05）. Conclusion Salmeterol xinafoate and fluticasone propionate powder for inhalation combined with noninvasive ventilation can significantly improve the lung function of COPD patients complicated with geriatric respiratory failure, and improve the renal hemodynamics without impairing the renal func- tion, therefore improve the prognosis.