无创正压通气治疗慢性阻塞性肺疾病伴呼吸衰竭患者疗效及对炎性反应等指标的影响

Noninvasive positive pressure ventilation improves inflammatory reaction and respiratory muscle load in patients with COPD and respiratory failure

目的 观察慢性阻塞性肺疾病伴呼吸衰竭患者行无创正压通气治疗的效果,并分析其对相关指标的影响。方法 选择2015年4月—2017年4月陆军总医院263临床部呼吸内科接受治疗的慢性阻塞性肺疾病伴呼吸衰竭患者84例作为研究对象,随机数字表法分为观察组和对照组各42例。对照组患者行常规治疗,观察组患者在对照组基础上行无创正压通气治疗。观察、比较2组患者治疗前后心率(HR)、呼吸频率(RR)、肺通气指标、血气分析指标、乳酸(Lac)、N末端脑钠肽前体(NT-proBNP)、炎性介质(TNF-α、IL-6、IL-8)的变化情况。结果 治疗后,2组患者的肺通气指标均较治疗前显著改善,并且观察组改善更显著(t=13.950、9.708、7.894,P均=0.000);2组患者的HR、RR、pH、PaO_2、PaCO_2均较治疗前显著改善,并且观察组患者改善更为显著(t=6.073、7.184、5.973、8.013、6.823,P均=0.000);2组患者的Lac、NT-proBNP水平均较治疗前显著下降,并且观察组患者下降更为显著(t=3.964、3.817,P均=0.000);2组患者的TNF-α、IL-6、IL-8水平均较治疗前显著下降,并且观察组患者下降更为显著(t=4.085、3.363、2.856,P<0.01或P<0.05)。结论 无创正压通气能够显著改善慢性阻塞性肺疾病伴呼吸衰竭患者的肺通气指标、血气指标,降低Lac、NT-proBNP及炎性介质水平,有助于呼吸肌负荷的减轻,具有积极的临床意义。

Objective To observe the effects of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease and respiratory failure,and to analyze its effect on related indicators. Methods Eighty-four cases of patients with chronic obstructive pulmonary disease and respiratory failure divided into the observation group （42 cases） and control group （42 cases）. The patients of control group were treated with conventional treatment. Based on control group, the patients of observation group were treated with noninvasive positive pressure ventilation. The changes of heart rate （HR）, respiratory rate （RR）, pulmonary ventilation indexes, blood gas analysis indexes and lactate （Lac）, N-terminal pro-brain natriuretic peptide （NT-proBNP）, inflammatory mediators （TNF-α,IL-6,IL-8） of two groups were observed and compared. Results After the appropriate treatment, the pulmonary ventilation indexes of the two groups were all significantly improved than before, and the patients of the observation group got more significant improvement （ t = 13.950, t =9.708, t =7.894, P = 0.000 , P =0.000, P =0.000）. The blood gas analysis indexes of the two groups were all significantly improved than before,and the patients of the observation group got more significant improvement （ t =6.073, t =7.184, t =5.973, t =8.013, t =6.823, P = 0.000, P =0.000, P =0.000, P =0.000, P =0.000）. The Lac, NT-proBNP levels of the two groups were all significantly increased than before, and the patients of the observation group got more significant incline （ t =3.964, t = 3.817 , P =0.000, P =0.000）. The TNF-α, IL-6, IL-8 levels of the two groups were all significantly increased than before, and the patients of the observation group got more significant decline （ t = 4.085, t =3.363, t =2.856, P = 0.000, P = 0.024 , P =0.003）. Conclusion Noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease and respiratory failure can significantly improve the patient＇s pulmonary ventilation indexes,blood gas indexes,and decrease the Lac, NT-proBNP and inflammatory mediators levels, which contributes to the reduction of respiratory muscle load and has a positive clinical significance.