复方异丙托溴氨联合布地奈德对慢性阻塞性肺疾病急性发作患者的疗效

Effect of Compound Ipratropium Bromide and budesonide in patients with acute chronic obstructive pulmonary disease

目的探讨复方异丙托溴氨联合布地奈德雾化吸入对慢性阻塞性肺疾病急性发作(AECOPD)患者的疗效及Toll样受体4/核转录因子κB(TLR4/NF-κB)炎性信号通路的影响。方法选取224例AECOPD患者作为研究对象,按照随机数字表法均分为观察组与对照组,每组112例,2组患者均在正压通气模式下进行非侵入性机械通气并接受常规治疗,对照组雾化吸入复方异丙托溴铵,观察组雾化吸入复方异丙托溴铵与布地奈德。治疗1周后,比较2组患者的临床疗效、肺功能指标、血气指标和炎性通路相关指标。结果观察组通气时间为(3.7±0.7)d,总治疗时间为(6.6±1.1)d,均明显短于对照组[(6.5±1.3)d,(11.5±1.6)d)]。治疗后,2组第一秒用力呼气量(FEV_(1))、FEV_(1)与预计值百分比(FEV_(1)%)、FEV_(1)与用力肺活量比值(FEV_(1)/FVC)、氧气分压(PaO 2)、氧气饱和度(SpO 2)和呼吸衰竭指数(RFI)均显著升高,且观察组显著高于对照组,而二氧化碳分压(PaCO 2)水平显著下降,且观察组显著低于对照组(P<0.05)。治疗后,2组外周血肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)、TLR4 mRNA和NF-κB mRNA均明显降低,且观察组明显低于对照组(P<0.05)。结论AECOPD患者雾化吸入复方异丙托溴铵和布地奈德可显著改善患者的肺功能、血气指标和炎症反应,提高临床疗效,缩短治疗时间。

Objective To investigate the effect of Compound Ipratropium Bromide combined with budesonide in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and Toll-like receptors 4/nuclear factorκB(TLR4/NF-κB)inflammatory signaling pathway.Methods A total of 224 patients with AECOPD were enrolled in the study.They were randomly divided into observation group and control group,112 patients in each group.Both groups were in positive pressure ventilation.Non-invasive mechanical ventilation was performed in the mode and received routine treatment.On this basis,Compound Ipratropium Bromide was inhaled in the control group and the observation group which used a combination of Compound Ipratropium Bromide and budesonide inhalation.After 1 week of treatment,the clinical efficacy,lung function index,blood gas index and inflammatory pathway related indicators of the 2 groups were compared.Results The ventilation time and total treatment time of the observation group were(3.7±0.7)d and(6.6±1.1)d,which were significantly shorter than those of the control group[(6.5±1.3)d and(11.5±1.6)d].After treatment,forced expiratory volume in one second(FEV 1),FEV 1 and projected percentage(FEV 1%pred),ratio of FEV 1 to forced vital capacity(FEV 1/FVC),partial pressure of oxygen in artery(PaO 2),pulse oxygen saturation(SpO 2)and respiratory failure index(RFI)were significantly increased in the 2 groups,and those of observation group was significantly higher than those of control group,while the partial pressure of carbon dioxide in artery(PaCO 2)level was significantly lower,and those of observation group was significantly lower than of control group(P<0.05).After treatment,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),TLR4 mRNA and NF-κB mRNA in the peripheral blood of the 2 groups were significantly decreased,and those of observation group was significantly lower than of control group(P<0.05).Conclusion Inhalation of Compound Ipratropium Bromide and budesonide in patients with AECOPD can significantly improve the circulatory inflammatory response,improve lung function and blood gas index,improve the treatment effect,and shorten the treatment time.