无创正压通气联合异丙托溴铵间断雾化吸入对重症支气管哮喘患者呼吸功能及血清hs-CRP、IFN-γ水平变化的影响

Effects of noninvasive positive pressure ventilation combined with ipratropium bromide intermittent inhalation on respiratory function and serum hs-CRP and IFN-γ levels in patients with severe bronchial asthma

目的探讨无创正压通气联合异丙托溴铵间断雾化吸入对重症支气管哮喘（BA）患者呼吸功能及血清超敏C-反应蛋白（hs-CRP）、干扰素-γ（IFN-γ）水平变化的影响。方法选取重症BA患者84例，按照随机数字表法分为对照组和观察组，每组42例。对照组给予常规治疗方案，观察组在对照组基础上给予无创正压通气联合异丙托溴铵间断雾化吸入治疗。比较两组治疗前后呼吸功能[呼吸频率（RR）、分钟通气量（MV）、第1秒用力呼气容积（FEV1）、用力呼气肺活量（FVC）]，血清hs-CRP、IFN-γ水平，呼出气一氧化氮（FeNO）浓度变化情况及SF-36生存质量评分。结果①呼吸功能：治疗前，两组RR、MV、FEV1及FVC比较差异未见统计学意义（P〉0.05）；治疗后，观察组RR低于对照组，MV、FEV1及FVC高于对照组，差异有统计学意义（P〈0.05）。②血清hs-CRP、IFN-γ：治疗前，两组血清hs-CRP、IFN-γ水平比较差异未见统计学意义（P〉0.05）；治疗后，观察组血清hs-CRP低于对照组，IFN-γ高于对照组，差异有统计学意义（P〈0.05）。③FeNO变化情况：治疗前，两组FeNO水平比较差异未见统计学意义（P〉0.05）；治疗后，两组FeNO水平均有所下降，且观察组低于对照组，差异有统计学意义（P〈0.05）。④生存质量：治疗前两组SF-36生存质量评分比较差异未见统计学意义（P〉0.05）；治疗后，观察组生存质量评分高于对照组，差异有统计学意义（P〈0.05）。结论给予重症BA患者无创正压通气联合异丙托溴铵间断雾化吸入治疗，可有效改善患者的呼吸功能及血清hs-CRP、IFN-γ水平，临床效果显著，有利于提高BA患者的生存质量。

Objective To investigate the effects of noninvasive positive pressure ventilation combined with ipratropium bromide intermittent inhalation on respiratory function and serum hypersensitive C-reactive protein （hs-CRP）, interferon-γ （IFN-γ） levels in patients with severe bronchial asthma （BA）.Methods Eight-four patients with severe BA were randomly divided into control group and observation group, with 42 cases in each group. The control group was given conventional treatment regimen, and on the basis of this, the observation group was given noninvasive positive pressure ventilation combined with ipratropium bromide intermittent inhalation therapy additionally. Respiratory function [respiratory rate （RR）, minute ventilation （MV）, forced expiratory volume in one second （FEV1）, forced expiratory volume （FVC）], serum hs-CRP, IFN-γ level, exhaled nitric oxide （FeNO） concentration and SF-36 quality of life score were compared between the two groups before and after treatment.Results ①Respiratory function： before treatment, there were no significant differences in RR, MV, FEV1 and FVC between the two groups （P〉0.05）; after treatment, the RR in observation group was significantly lower than that in control group, MV, FEV1 and FVC were significantly higher than those in control group （P〈0.05）. ② Serum hs-CRP, IFN-γ： the differences of serum hs-CRP, IFN-γ levels in two groups before treatment were not statistically significant （P〉0.05）; after treatment, serum hs-CRP in observation group was significantly lower than that in control group, and IFN-γ was significantly higher than that in control group （P〈0.05）. ③ FeNO changes： there was no significant difference in FeNO between the two groups before treatment （P〉0.05）; after treatment, the FeNO of both groups decreased, and FeNO in observation group was significantly lower than that in control group, the difference was statistically significant （P〈0.05）. ④ Quality of life： there was no significant difference in SF-36 quality of life between the two groups before treatment （P〉0.05）; after treatment, the SF-36 quality of life in observation group was significantly higher than that in control group （P〈0.05）.Conclusions Noninvasive positive pressure ventilation combined with ipratropium bromide intermittent inhalation therapy, in the treatment of severe BA, can effectively improve the respiratory function and serum hs-CRP and IFN-γ levels, has significant clinical effect, and can improve the quality of life.