噻托溴铵联合无创机械通气对重度稳定期慢性阻塞性肺疾病患者肺功能及血清炎性因子的影响

Effect of Tiotropium bromide combined with non-invasive mechanism ventilation on the pulmonary function and serum inflammatory cytokines of patients with severe stable chronic obstructive pulmonary disease

目的探讨噻托溴铵联合无创机械通气对重度稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者肺功能及血清炎性因子的影响。方法选择2013年2月至2015年12月于本院确诊并接受治疗的60例COPD患者为研究对象。采用随机数表法将其分为A组(噻托溴铵治疗)和B组(噻托溴铵联合无创机械通气治疗)。两组患者均治疗8周,比较两组患者治疗前后血气指标、血清炎性因子水平及肺功能变化情况。结果治疗8周后,两组患者动脉血氧分压(arterial partial pressure of oxygen,PaCO_2)较治疗前均显著升高(P<0.05),动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_2)较治疗前均显著降低(P<0.05);两组患者PaCO_2比较均无显著差异(P>0.05),B组患者PaCO_2显著低于A组(P<0.05)。治疗8周后,两组患者第一秒用力呼气量(forced expiratory volume in first second,FEV_1)占预计值百分比(FEV_1%预计值)、FEV_1占用力肺活量(forced vital capacity,FVC)百分比(FEV_1/FVC)及深吸气量(inspiratory capacity,IC)均显著高于治疗前(P<0.05);B组患者FEV_1%预计值、FEV_1/FVC及IC均显著高于A组(P<0.05)。治疗8周后,两组患者血清白介素(interleukin,IL)-6、IL-8及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均显著低于治疗前(P<0.05),B组患者血清IL-6、IL-8及TNF-α水平均显著低于A组(P<0.05)。结论与单独应用噻托溴铵相比,噻托溴铵联合无创机械通气治疗重度稳定期COPD,能够显著改善患者肺功能,减轻肺部炎性反应,提高其生活质量。

Objective To explore the effect of Tiotropium bromide combined with non-invasive ventilation on the pulmonary function and serum inflammatory cytokines in patients with severe stable chronic obstructive pulmonary disease(COPD).Method60patients with severe stable COPD in our hospital from Februrary2013to December2015were selected as the subjects.They were randomly divided into group A(treated by Tiotropium bromide)and group B(treated by Tiotropium bromide combined with non-invasive mechanism ventilation).Two groups of patients were treated for8weeks,the blood gas indexes,serum inflammatory factors levels and pulmonary function changes were compared between the two groups before and after treatment.Result After8weeks of treatment,arterial partial pressure of oxygen(PaO2)of the two groups were significantly higher than before treatment(P<0.05),the arterial partial pressure of carbon dioxide(PaCO2)of the two groups were significantly lower than before treatment(P<0.05).After8weeks of treatment,there was no significant difference in PaO2between the two groups(P>0.05),and the PaCO2of group B was significantly lower than that of group A(P<0.05).After8weeks of treatment,forced expiratory volume in first second(FEV1)%pred,FEV1/forced vital capacity(FVC),and inspiratory capacity(IC)of the two groups were significantly higher than those before treatment(P<0.05).The FEV1%pred,FEV1/FVC and IC of group B were significantly higher than group A(P<0.05).After8weeks of treatment,serum interleukin(IL)-6,IL-8and tumor necrosis factor-α(TNF-α)of the two groups were significantly lower than those before treatment(P<0.05),the serum IL-6,IL-8and TNF-αlevels of group B were significantly lower than that of group A(P<0.05).Conclusion Compared with Tiotropium bromide alone,Tiotropium bromide combined with non-invasive mechanical ventilation in the treatment of severe stable COPD,can significantly improve the pulmonary function,reduce the inflammatory response and improve the quality of life.