无创正压通气联合振动呼气期正压装置对老年慢性阻塞性肺疾病急性加重期患者肺功能、炎性因子及短期预后的影响

Effects of noninvasive positive pressure ventilation combined with positive expiratory pressure device on pulmonary function,inflammatory factors and short-term prognosis in older adult patients with acute exacerbations of chronic obstructive pulmonary disease

目的:探讨无创正压通气联合振动呼气期正压(PEP)装置对老年慢性阻塞性肺疾病急性加重期(AECOPD)患者肺功能、炎性因子及短期预后的影响,为临床治疗和预后评价提供客观依据。方法:选取台州市中心医院2016年1月至2018年12月收治的老年AECOPD患者83例为研究对象,采用随机数字表法分为对照组(38例)和研究组(45例)。对照组予单纯无创正压通气治疗,研究组予无创正压通气联合振动PEP装置治疗,治疗7 d后,比较两组肺功能指标、血气分析指标、炎性因子水平和疗效评分的变化。结果:治疗后,两组动脉氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))均显著升高,二氧化碳分压(PaCO_(2))均显著降低(均 P<0.05),研究组PaO_(2)、PaCO_(2)和PaO_(2)/FiO_(2)改善的幅度更大( t=2.261、6.854、2.040,均 P<0.05);两组第一秒用力呼气容积(FEV 1)/用力肺活量(FVC)的比值、第一秒用力呼气容积占预计值(FEV 1/Pre)和每分钟最大通气量(MVV)均显著升高(均 P<0.05),且研究组升高幅度更大( t=2.442、2.120、2.944,均 P<0.05);两组血清白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)和超敏C反应蛋白(hs-CRP)水平均显著降低(均 P<0.05),且研究组降低幅度更大( t=7.978、10.857、8.543,均 P<0.05);研究组住院天数、抗生素使用天数、慢性阻塞性肺病评估测试评分、圣乔治呼吸问卷评分分别为(7.52±1.38)d、(7.14±1.38)d、(18.95±4.76)分、(1.73±4.21)分,均显著短于、低于对照组的(8.55±1.47)d、(8.25±1.45)d、(8.07±5.81)分、(55.97±5.28)分( t=-2.510、-2.722、-7.943、-10.351,均 P<0.05)。 结论:无创正压通气联合振动PEP装置能够有效改善老年AECOPD患者肺功能,降低炎性因子水平,改善短期预后,具有显著创新性和科学性,有临床推广意义。

Objective To investigate the effects of noninvasive positive pressure ventilation combined with positive expiratory pressure device on pulmonary function,inflammatory factors and short-term prognosis in older adult patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD),which provide objective evidence for clinical treatment and prognosis evaluation of this disease.Methods Eighty-three older adult patients with AECOPD who received treatment in Taizhou Central Hospital,China between January 2016 and December 2018 were included in this study.They were randomly assigned to undergo either noninvasive positive pressure ventilation(control group,n=38)or noninvasive positive pressure ventilation combined with positive expiratory pressure device(study group,n=45)for 7 days.Pulmonary function,blood gas indexes,inflammatory factor levels and curative effect were compared between the two groups.Results After treatment,partial pressure of oxygen(PaO_(2))and oxygenation index(PaO_(2)/FiO_(2))in each group were significantly increased,and partial pressure of carbon dioxide(PaCO_(2))was significantly decreased,compared with before treatment(all P<0.05).The degree of improvement in PaO_(2),PaCO_(2) and PaO_(2)/FiO_(2) in the study group was greater than that in the control group(t=2.261,6.854,2.040,all P<0.05).The ratio of forced expiratory volume in the first second(FEV1)to forced vital capacity(FEV1/FVC),the ratio of FEV1 to predicted value(FEV1/Pre),and the maximum voluntary ventilation(MVV)per minute in each group were significantly increased compared with before treatment.After treatment,the degree of increase in FEV1/FVC,FEV1/Pre,and MVV in the study group was greater than that in the control group(t=2.442,2.120,2.944,all P<0.05).After treatment,serum levels of inerleukin-8,tumor necrosis factor-α,and high-sensitivity C-reactive protein in each group were significantly decreased compared with before treatment(all P<0.05).After treatment,the degree of decrease in serum levels of inerleukin-8,tumor necrosis factor-α,and high-sensitivity C-reactive protein in the study group was significantly greater than that in the control group(t=7.978,10.857,8.543,all P<0.05).Length of hospital stay,duration of antibiotic use,chronic obstructive pulmonary disease assessment test score and St.George's Respiratory Questionnaire score in the study group were(7.52±1.38)days,(7.14±1.38)days,(18.95±4.76)points,(1.73±4.21)points,respectively,which were significantly shorter/lower than those in the control group[(8.55±1.47)days,(8.25±1.45)days,(8.07±5.81)points,(55.97±5.28)points,t=-2.510,-2.722,-7.943,-10.351,all P<0.05].Conclusion Noninvasive positive pressure ventilation combined with positive expiratory pressure device can effectively improve the pulmonary function of older adult patients with AECOPD,decrease the level of inflammatory factors,and improve short-term prognosis.This study is highly innovative and scientific and is of significance for clinical promotion.