大剂量氨溴索联合无创机械通气对老年慢性阻塞性肺疾病合并呼吸衰竭患者的临床效果分析

Clinical Effect of High-dose Ambroxol Combined with Non-invasive Mechanical Ventilation on Elderly Patients with Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

目的:探析大剂量氨溴索联合无创机械通气治疗老年慢性阻塞性肺疾病(COPD)伴呼吸衰竭(RF)的临床价值。方法:选取我院自2017年3月至2018年12月间收治的老年COPD合并RF患者90例作为试验对象,均行抗感染、吸痰、解痉等常规治疗,按照随机原则分成两组,对照组患者45例使用无创机械通气治疗,观察组在上述基础上联合使用盐酸氨溴索治疗,连续治疗1周,比较两组患者治疗前后氧化应激反应、炎性细胞因子水平H和呼吸功能的变化,对比其治疗预后效果情况。结果:治疗前两组患者治疗前超氧化物歧化酶(SOD)、丙二醛(MDA)等氧化应激指标及C-反应蛋白(CRP)无显著差异,治疗4d、7d时观察组MDA和CRP指标均显著低于对照组,SOD水平高于对照组(P<0.05);治疗4d、7d时两组患者内源性呼气末正压(PEEPi)、气道阻力和静态肺顺应性(Cst)较治疗前差异显著(P<0.05),观察组PEEPi、气道阻力均显著低于对照组,Cst则高于对照组(P<0.05);两组患者死亡率无显著差异,观察组呼吸机相关性肺炎(VAP)发生率显著低于对照组(P<0.05)。结论:大剂量氨溴索配合无创机械通气治疗老年COPD伴RF可更好的改善患者呼吸功能和氧化应激反应,提升治疗安全性,值得推广。

Objective:To explore the clinical value of high dose ambroxol combined with non-invasive mechanical ventilation in the treatment of chronic obstructive pulmonary disease(COPD)with respiratory failure(RF)in elderly patients with COPD.Methods:From March 2017 to December 2018,90 elderly patients with COPD combined with RF were selected as experimental subjects.All of them were treated with anti-infection,sputum and spasmolysis routine therapy,and were divided into two groups according to the random principle.45 patients in the control group were treated with noninvasive mechanical ventilation.The observation group was treated with ambroxol hydrochloride for one week on the above basis.The oxidative stress reaction before and after treatment was compared between the two groups.The changes of inflammatory cytokines H and respiratory function were compared.Results:before treatment,there was no significant difference in oxidative stress indexes such as superoxide dismutase(SOD),malondialdehyde(MDA)and C-reactive protein(CRP)between the two groups before treatment.The MDA and CRP indexes in the observation group were significantly lower than those in the control group on the 7th day after treatment.The level of SOD was higher than that of control group(P<0.05).There were significant differences in intrinsic positive end-expiratory pressure(PEEPi),airway resistance and static compliance(Cst)between the two groups at 4 days and 7 days after treatment(P<0.05).The airway resistance of PEEPi,in the observation group was significantly lower than that in the control group(P<0.05).Cst was higher than that of control group(P<0.05).There was no significant difference in mortality between the two groups,and the incidence of VAP in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:High dose ambroxol combined with noninvasive mechanical ventilation can improve respiratory function and oxidative stress in elderly patients with COPD and RF,enhance the safety of treatment,and is worth popularizing.