慢性阻塞性肺疾病急性加重期合并高碳酸血症患者无创机械通气治疗前后炎症状态及免疫功能的变化研究

Inflammatory state and immune function in patients experiencing acute exacerbation of chronic obstructive pulmonary disease complicated with hypercapnia before and after noninvasive mechanical ventilation

目的:观察慢性阻塞性肺疾病急性加重期(AECOPD)合并高碳酸血症患者无创机械通气治疗前后炎症状态及免疫功能的变化。方法:回顾性分析台州市中心医院2018年8月至2019年8月收治的AECOPD合并高碳酸血症患者120例的临床资料,按照治疗方法的不同将其分为无创通气组(57例)及常规组(63例)。观察两组治疗疗效,比较两组治疗前后炎性因子水平[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)]、免疫指标[辅助性T淋巴细胞(CD 4+)、抑制/杀伤性T淋巴细胞(CD 8+)、CD 4+/CD 8+]、血气分析指标[动脉血二氧化碳分压(PaCO 2)、动脉血氧分压(PaO 2)、pH]及肺功能指标[第1秒用力肺活量(FEV1)、用力肺活量(FVC)、最大呼气流量(PEF)];统计两组患者治疗期间痰液阻塞、胃胀气等不良反应发生情况。结果:无创通气组治疗总有效高于常规组(P<0.05);无创通气组治疗后TNF-α、IL-6、CRP水平[(61.98±5.16)ng/L、(19.77±3.41)ng/L、(15.39±3.22)mg/L]水平低于常规组[(68.24±5.12)ng/L、(21.04±3.52)ng/L、(19.28±3.50)mg/L](t=6.664、2.003、6.314,均P<0.05),CD 4+、CD 4+/CD 8+值[(29.28±2.81)、(1.18±0.17)]高于常规组[(27.34±2.96)、(1.09±0.15)](t=3.672、3.081,均P<0.05);无创通气组治疗后PaCO 2[(48.34±6.92)mmHg]低于常规组[(53.09±7.07)mmHg](t=3.712,P<0.05),PaO 2、pH值及FEV1、FVC、PEF[(70.61±9.82)mmHg、(7.35±0.15)、(2.39±0.48)L、(2.50±0.46)L、(4.65±0.75)L/s]高于常规组[(65.19±8.23)mmHg、(7.29±0.14)、(2.16±0.47)L、(2.21±0.45)L、(4.06±0.69)L/s](t=3.287、2.266、2.650、3.488、4.488,均P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论:对AECOPD合并高碳酸血症患者给予无创机械通气治疗,可改善患者炎症状态及免疫功能,提高肺功能,减轻机体缺氧程度。

Objective To investigate the inflammatory state and immune function of patients experiencing acute exacerbation of chronic obstructive pulmonary disease complicated by hypercapnia before and after noninvasive mechanical ventilation.Methods The clinical data of 120 patients experiencing acute exacerbation of chronic obstructive pulmonary disease complicated by hypercapnia who received treatment in Taizhou Central Hospital from August 2018 to August 2019 were retrospectively analyzed.According to different treatment methods,they were divided into a noninvasive ventilation group(n=57)and a conventional treatment group(n=63).The therapeutic effect was observed in each group.Before and after treatment,serum levels of inflammatory factors(tumor necrosis factor-α,interleukin-6,C-reactive protein),immune indexes(CD4+,CD8+,CD4+/CD8+),blood gas analysis indexes(PaCO2,PaO2,pH)and pulmonary function indexes(forced expiratory volume in 1 second,forced vital capacity,peak expiratory flow)were measured in each group.Adverse reactions such as sputum obstruction and gastric distension during treatment were statistically analyzed.Results Total effective rate in the noninvasive ventilation group was significantly higher than that in the conventional treatment group(P<0.05).After treatment,serum levels of tumor necrosis factor-α,interleukin-6,C-reactive protein were(61.98±5.16)ng/L,(19.77±3.41)ng/L,(15.39±3.22)mg/L respectively in the noninvasive ventilation group,which were significantly lower than those in the conventional treatment group[(68.24±5.12)ng/L,(21.04±3.52)ng/L,(19.28±3.50)mg/L,t=6.664,2.003,6.314,all P<0.05].After treatment,CD4+and CD4+/CD8+were(29.28±2.81)and(1.18±0.17)respectively in the non-invasive ventilation group,which were significantly higher than(27.34±2.96)and(1.09±0.15)in the conventional treatment group(t=3.672,3.081,both P<0.05).After treatment,PaCO2[(48.34±6.92)mmHg]in the noninvasive ventilation group was lower than that in the conventional treatment group[(53.09±7.07)mmHg,t=3.712,P<0.05].PaO2,pH,forced expiratory volume in 1 second,forced vital capacity and peak expiratory flow were(70.61±9.82)mmHg,(7.35±0.15),(2.39±0.48)L,(2.50±0.46)L,(4.65±0.75)L/s,respectively in the non-invasive ventilation group,which were significantly higher than those in the conventional treatment group[(65.19±8.23)mmHg,(7.29±0.14),(2.16±0.47)L,(2.21±0.45)L,(4.06±0.69)L/s,t=3.287,2.266,2.650,3.488,4.488,all P<0.05].There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Noninvasive mechanical ventilation for patients experiencing acute exacerbation of chronic obstructive pulmonary disease complicated by hypercapnia can improve the inflammatory state and immune function,enhance lung function and reduce the degree of hypoxia.