噻托溴铵联合双水平气道正压通气治疗慢性阻塞性肺疾病急性加重期的疗效分析

Analysis of the efficacy of tiotropium bromide combined with BiPAP in treatment of patients with AECOPD

目的分析噻托溴铵联合双水平气道正压通气(BiPAP)治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者的疗效.方法选取运城同德医院2014-2016年诊治的AECOPD患者60例为研究对象,采用随机数字表法分成对照组30例和观察组30例.对照组患者在常规治疗基础上给予BiPAP治疗,观察组患者给予噻托溴铵联合BiPAP治疗.连续治疗12周,比较两组治疗效果、肺功能、动脉血气分析、血清炎性因子水平、生活质量的差异.结果治疗后对照组总有效率为76.67%,观察组总有效率为96.67%,差异有统计学意义(χ2=5.192,P<0.05).治疗前,两组一秒用力呼气容积(FEV1)、一秒用力呼气容积/用力肺活量(FEV1/FVC)、一秒用力呼气容积百分比(FEV1%)差异均无统计学意义(均P>0.05);治疗后,观察组FEV1、FEV1/FVC、FEV1%分别为(2.73±0.63)L、(77.53±10.68)、(73.85±11.21),均高于对照组的(2.02±0.57)L、(68.57±11.25)、(64.38±12.74),差异均有统计学意义(t=4.577、3.163、3.056,均P<0.05).治疗前,两组氧分压(PaO2)、二氧化碳分压(PaCO2)差异均无统计学意义(均P>0.05);治疗后,观察组PaO2(80.48±15.64)mmHg,高于对照组的(66.05±12.05)mmHg,PaCO2(53.11±8.38)mmHg,低于对照组的(60.33±9.95)mmHg,差异均有统计学意义(t=4.003、3.039,均P<0.05).治疗前,两组血清白介素6(IL-6)、肿瘤坏死因子(TNF-α)、高敏C反应蛋白(hs-CRP)水平差异均无统计学意义(均P>0.05);治疗后,观察组血清IL-6、TNF-α、hs-CRP分别为(85.83±27.35)ng/L、(85.35±29.15)ng/L、(2.25±0.64)mg/L,均低于对照组的(102.57±32.65)ng/L、(101.45±32.14)ng/L、(2.88±0.78)mg/L,差异均有统计学意义(t=2.152、2.032、3.420,均P<0.05).治疗前,两组患者生活质量调查表(SF-36)评分差异无统计学意义(P>0.05);治疗后,观察组SF-36评分[(92.48±8.64)分]高于对照组[(79.22±17.04)分],差异有统计学意义(t=3.0959,P<0.05).结论噻托溴铵联合BiPAP对AECOPD具有更好的疗效,有助于改善患者的肺功能和血气指标,调节机体微炎症状态,使患者获得更好的生活质量.

Objective To analyze the efficacy of tiotropium bromide combined with bi level positive airway pressure ventilation(BiPAP)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods From 2014 to 2016,60 patients with AECOPD in Tongde Hospital were selected in the research,and were randomly divided into the control group and observation group according to the digital table,with 30 cases in each group.The control group was given BiPAP treatment on the basis of conventional treatment,and the observation group was given tiotropium bromide combined with BiPAP treatment.The therapeutic effects,pulmonary function,arterial blood gas analysis,serum inflammatory factors and quality of life were compared between the two groups after 12 weeks of continuous treatment.Results After treatment,the total effective rate of the control group was 76.67%,which of the observation group was 96.67%,the difference between the two groups was statistically significant(χ2=5.192,P<0.05).Before treatment,one second forced expiratory volume(FEV1),forced expiratory volume in one second/forced vital capacity(FEV1/FVC),one second forced expiratory volume percentage(FEV1%)between the two groups showed no statistically significant differences(all P>0.05).After treatment,the FEV1,FEV1/FVC and FEV1%in the observation group were(2.73±0.63)L,(77.53±10.68)%,(73.85±11.21)%,respectively,which were higher than those in the control group[(2.02±0.57)L,(68.57±11.25)%,(64.38±12.74)%],the differences between the two groups were statistically significant(t=4.577,3.163,3.056,all P<0.05).Before treatment,the oxygen partial pressure(PaO2),partial pressure of carbon dioxide(PaCO2)between the two groups showed no statistically significant differences(all P>0.05).After treatment,the PaO2 of the observation group[(80.48±15.64)mmHg]was higher than that of the control group[(66.05±12.05)mmHg],the PaCO2 of the observation group[(53.11±8.38)mmHg]was lower than that of the control group[(60.33±9.95)mmHg],the differences between the two groups were statistically significant(t=4.003,3.039,all P<0.05).Before treatment,the serum interleukin 6(IL-6),tumor necrosis factorα(TNF-α),high sensitive C reactive protein(hs-CRP)levels between the two groups showed no significant differences(all P>0.05).After treatment,the levels of serum IL-6,TNF-alpha and hs-CRP in the observation group were(85.83±27.35)ng/L,(85.35±29.15)ng/L,(2.25±0.64)mg/L,respectively,which were lower than those in the control group[(102.57±32.65)ng/L,(101.45±32.14)ng/L,(2.88±0.78)mg/L],there were significant differences between two groups(t=2.152,2.032,3.420,all P<0.05).Before treatment,the quality of life questionnaire(SF-36)score between the two groups had no statistically significant difference(P>0.05).After treatment,the SF-36 score of the observation group[(92.48±8.64)points]was higher than the control group[(79.22±17.04)points],there was statistically significant difference between the two groups(t=3.095,P<0.05).Conclusion Tiotropium bromide combined with BiPAP has better curative effect in the treatment of AECOPD,it can help to improve the patients'lung function and blood gas index,regulate the body's inflammatory state,so that patients get better quality of life,it is worthy of clinical application.