纳美芬联合无创正压机械通气治疗老年COPD合并重症Ⅱ型呼吸衰竭的疗效及对患者血清人Clara细胞分泌蛋白、巨噬细胞刺激蛋白水平的影响研究

Study on impact of nalmefene plus non-invasive positive pressure ventilation on serum human Clara cell secretion protein 16 and human macrophage stimulating protein for elderly chronic obstructive pulmonary disease patients with severe typeⅡrespiratory failure

目的探讨对老年慢性阻塞性肺疾病(COPD)合并重症Ⅱ型呼吸衰竭的患者联合使用无创正压机械通气(NIPPV)和纳美芬治疗的临床效果。方法选取老年COPD患者76例,所有患者均合并重症Ⅱ型呼吸衰竭,病例收集时间在2018年5月至2020年1月;按照均等单盲法将76例患者分为对照组和研究组,各38例;两组患者均采用NIPPV联合常规治疗,而研究组在此基础上给予患者纳美芬治疗,对比两组临床治疗效果。结果对照组和研究组在治疗前肺功能指标、血气分析指标、Clara细胞分泌蛋白(CC16)和巨噬细胞刺激蛋白(MSP)水平对比均无明显差异(P>0.05);治疗后,研究组肺功能指标水平、pH值、动脉血氧分压(PaO_(2))和CC16水平高于对照组,动脉二氧化碳分压(PaCO-(2))和MSP水平低于对照组,两组对比差异显著(P<0.05)。结论NIPPV与纳美芬联合治疗有助于改善老年COPD合并重症Ⅱ型呼吸衰竭患者的肺功能及血气分析指标,提高患者治疗效果的同时提升血清CC16水平,降低MSP水平,治疗效果显著,具备临床推广应用价值。

Objective To discuss the clinical effects of non-invasive positive pressure ventilation(NIPPV)plus nalmefenein elderly chronic obstructive pulmonary disease(COPD)patients with severe typeⅡrespiratory failure.Methods 76 elderly COPD patients with severe typeⅡrespiratory failure treated from May 2018 to January 2020 in our hospital were selected.According to single-blind method,patients were divided into control group(38 cases)and study group(38 cases).Both of groups were taken NIPPV and routine treatment.The study group was taken nalmefene treatment.Therapeutic effects were probed.Results Before treatment,there were no statistical significantly differences between-group differences of lung function indicators,blood gas analysis index,human Clara cell secretion protein 16(CC16)and human macrophage stimulating protein(MSP)levels(P>0.05).After treatment,the lung function index,pH values,arterial partial pressure of oxygen(PaO_(2))and CC16 levels in the study group were higher than control group.The arterial partial pressure of carbon dioxide and(PaCO_(2))and MSP levels in the study group were lower than control group(P<0.05).Conclusion NIPPV combined with nalmefene can reduce MSP levels,and improve the lung function indicators,blood gas analysis index and CC16 levels.It is worthy of clinical promotion and application.