噻托溴铵联合无创呼吸机治疗COPD合并Ⅱ型呼吸衰竭疗效及对患者血气指标和炎症因子的影响

The Curative Effect of Tiotropium Combined with Non-invasive Ventilator on COPD and Type Ⅱ Respiratory Failure and Their Influences on Blood Gas Indexes and Inflammatory Factors

目的探讨噻托溴铵联合无创呼吸机治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的疗效。方法80例AECOPD合并Ⅱ型呼吸衰竭患者随机分为对照组(n=40)和观察组(n=40),对照组予以常规治疗及无创呼吸机辅助通气治疗,观察组在对照组基础上予以噻托溴铵治疗;比较两组临床疗效及血气分析指标、肺功能、炎症因子、免疫功能等变化。结果治疗总有效率,观察组为95.00%,对照组为77.50%,组间对比差异有统计学意义(P<0.05)。治疗后,观察组第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC及动脉血氧分压、动脉二氧化碳、氧合指数均明显优于对照组(P<0.05),血清C反应蛋白、降钙素原及白细胞介素-17水平均明显低于对照组(P<0.05)。治疗后,观察组CD3^+、CD4^+、CD4^+/CD8^+均明显高于对照组(P<0.05),CD8^+明显低于对照组(P<0.05)。两组治疗期间均无明显不良反应。结论噻托溴铵联合无创呼吸机治疗AECOPD合并Ⅱ型呼吸衰竭疗效显著,可有效缓解炎症反应,改善血气指标、肺功能及免疫功能。

Objective To explore curative effect of tiotropium combined with non-invasive ventilator on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and type II respiratory failure(T2RF).Methods 80 patients with AECOPD and T2RF were randomly divided into the control group(n=40)and observation group(n=40).The control group was given routine treatment and non-invasive ventilator-assisted ventilation,while the observation group was given tiotropium in addition of the control group.The clinical curative effect,changes in blood gas analysis indexes,pulmonary function,inflammatory factors and immune function were compared between the two groups.Results There were significant differences in total response rates of treatment between the observation group and control group(95.00%vs 77.50%)(P<0.05).After treatment,forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),FEV1/FVC,arterial oxygen partial pressure,arterial carbon dioxide and oxygenation index in the observation group were significantly better than those in the control group(P<0.05),and levels of serum C-reactive protein,procalcitonin and interleukin-17 were significantly lower than those in the control group(P<0.05).After treatment,CD3^+,CD4^+and CD4^+/CD8^+in the observation group were significantly higher than those in the control group(P<0.05),while CD8^+was significantly lower than that in the control group(P<0.05).There were no significant adverse reactions during treatment in either of group.Conclusion Curative effect of tiotropium combined with non-invasive ventilator is significant on COPD and T2RF,which can effectively alleviate inflammatory response,improve blood gas indexes,pulmonary function and immune function.