慢性阻塞性肺疾病合并呼吸衰竭患者行外周血TREM-1检测对序贯治疗切换点应用研究

Application of TREM-1 in peripheral blood as a switching point for sequential ventilation of patients with chronic obstructive pulmonary disease complicated with respiratory failure

目的:考察慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并呼吸衰竭患者行外周血髓样细胞触发受体-1(triggering receptor expressed on myeloid cells-1,TREM-1)检测对序贯治疗切换点应用研究。方法:收集120例COPD合并呼吸衰竭患者,随机分为对照组和观察组各60例。对照组接受2 h自主呼吸试验(spontaneous breathing trial,SBT)为无创序贯通气(non invasive positive pressure ventilation,NIPPV)选择时机,观察组接受外周血TREM-1≤90.0 pg/mL为NIPPV选择时机,检测两组患者机械通气治疗24 h后的应激激素、临床肺部感染评分和生命体征,记录两组的治疗时间和不良反应等。结果:两组的肾素(rennin,REN)、肾上腺素(Adrenaline,A)、去甲肾上腺素(noradrenaline,NA)和血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)比较,差异无统计学意义(P>0.05);与对照组比,观察组的临床肺部感染评分明显降低(P<0.05),两组患者的心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、pH、动脉二氧化碳分压(arterial carbon dioxide partial pressure,PaCO 2)和动脉氧分压(partialpressureofoxygen,PaO 2)比较,差异无统计学意义(P>0.05),两组重症监护室(intensive care nursing,ICU)监护时间比较,差异无统计学意义(P>0.05);与对照组比,观察组有创通气时间、总机械通气时间和住院时间均明显降低(P<0.05),两组死亡、呼吸机相关性肺炎及再次插管发生比较,差异无统计学意义(P>0.05)。结论:COPD合并呼吸衰竭患者有创-无创序贯通气治疗期间以TREM-1作为切换点,有利于缩短患者创通气时间、总机械通气时间和住院时间。

Objective:To investigate the application of the triggering receptor expressed on myeloid cells-1(TREM-1)in peripheral blood as a switching point for sequential ventilation of patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:A total of 120 COPD patients with respiratory failure from June 2017 to December 2018 were randomly divided into the control group and the observation group,with 60 cases in each group.The control group received 2 h spontaneous breathing trial(SBT)to select the time for non-invasive positive pressure ventilation(NIPPV).The observation group received TREM-1(≤90.0 pg/mL)test in peripheral blood as NIPPV choice time.The stress hormones,clinical pulmonary infection score and vital signs of twogroups after 24 h of mechanical ventilation were detected.The treatment time and the adverse reactions of twogroups were recorded.Results:There was no significant difference in rennin(REN),adrenaline(A),noradrenaline(NA)and angiotensinⅡ(AngⅡ)between twogroups(P>0.05).Compared with the control group,the clinical pulmonary infection score had decreased in the observation group(P<0.05).And the heart rate(HR),respiratory rate(respiratory rate)of twogroups had decreased(P<0.05).There was no significant difference in RR,pH,partial pressure of carbon dioxide(PaCO2)and partial pressure of oxygen(PaO2)between twogroups(P>0.05).There was no significant difference in intensive care(ICU)monitoring time betweentwo groups(P>0.05).Compared with the control group,the observation group had no significant difference in invasive ventilation time and total mechanical ventilation.The time of hospitalization and hospitalization had significantly decreased(P<0.05).There was no significant difference in mortality,ventilator-associated pneumonia and re-intubation between two groups(P>0.05).Conclusion:TREM-1 can be used as a switching point during invasive-noninvasive sequential ventilation for COPD patients with respiratory failure,which can shorten the time of invasive ventilation,total mechanical ventilation and hospitalization.