无创-有创序贯通气联合药物雾化吸入治疗老年重症哮喘并发Ⅱ型呼吸衰竭患者的效果探究

Study on the effect of noninvasive-invasive sequential ventilation combined with atomization inhalation in the treatment of elderly patients with severe asthma and type Ⅱ respiratory failure

目的探究老年重症哮喘并发Ⅱ型呼吸衰竭患者临床治疗中实施无创-有创序贯通气辅助药物雾化吸入的临床效果。方法70例老年重症哮喘并发Ⅱ型呼吸衰竭患者,随机分为研究组和对照组,每组35例。两组均接受常规治疗,在此基础上,研究组给予无创-有创序贯通气+雾化吸入治疗,对照组给予有创通气+雾化吸入治疗。对比两组治疗前后肺功能指标[第1秒用力呼气容积占预计值百分比(FEV1%)、第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)、最大呼气流量(PEF)]、血气指标[血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化分压(PaCO_(2))]、治疗效果、治疗前后炎症因子[白细胞介素-6(IL-6)、白细胞介素-18(IL-18)]水平。结果治疗前,两组FEV1%、FEV1/FVC、PEF水平对比差异无统计学意义(P>0.05);治疗后,研究组患者的FEV1%(68.29±7.91)%、FEV1/FVC(64.59±7.33)%、PEF(396.27±44.82)L/min均高于对照组的(58.41±7.63)%、(59.39±7.82)%、(327.21±45.91)L/min,差异具有统计学意义(P<0.05)。研究组的SpO_(2)(91.21±7.83)%、PaO_(2)(79.28±4.89)mm Hg(1 mm Hg=0.133 kPa)均高于对照组的(81.71±8.12)%、(65.15±4.02)mm Hg,PaCO_(2)(40.61±3.52)mm Hg低于对照组的(55.32±4.65)mm Hg,差异具有统计学意义(P<0.05)。研究组治疗总有效率为91.43%(32/35),明显高于对照组的68.57%(24/35),差异具有统计学意义(P<0.05)。治疗前,两组的IL-6、IL-18水平对比差异无统计学意义(P>0.05);治疗后,研究组的IL-6、IL-18分别为(14.53±2.08)、(252.64±67.43)ng/ml,均显著低于对照组的(20.71±3.15)、(293.08±62.48)ng/ml,差异具有统计学意义(t=9.686、2.603、P=0.000、0.011<0.05)。结论于老年重症哮喘并发Ⅱ型呼吸衰竭患者临床治疗中给予无创-有创序贯通气和雾化吸入,有助于改善患者肺功能,稳定血气指标,实现改善预后的目的。

Objective To investigate the clinical effect of noninvasive-invasive sequential ventilation combined with atomization inhalation in the treatment of elderly patients with severe asthma and type Ⅱ respiratory failure.Methods A total of 70 elderly patients with severe asthma and type Ⅱ respiratory failure were randomly divided into research group and control group,with 35 cases in each group.Both groups received conventional therapy.On this basis,the research group was treated with noninvasive-invasive sequential ventilation,and the control group was treated with invasive ventilation and atomization inhalation.The pulmonary function indicators[forced expiratory volume in the first second as a percentage of the predicted value(FEV1%),forced expiratory volume in the first second/forced vital capacity(FEV1/FVC),peak expiratory flow(PEF)]before and after treatment,blood gas indicators[blood oxygen saturation(SpO_(2)),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],therapeutic effect,inflammatory factors[interleukin-6(IL-6),interleukin-18(IL-18)]before and after treatment were compared between the two groups.Results Before treatment,there was no statistically significant difference in levels of FEV1%,FEV1/FVC and PEF between the two groups(P>0.05).After treatment,the FEV1%,FEV1/FVC and PEF of the research group were(68.29±7.91)%,(64.59±7.33)%and(396.27±44.82)L/min,which were all higher than(58.41±7.63)%,(59.39±7.82)%and(327.21±45.91)L/min of the control group,and the difference was statistically significant(P<0.05).The SpO_(2) and PaO_(2) of the research group were(91.21±7.83)%and(79.28±4.89)mm Hg(1 mm Hg=0.133 kPa),which were higher than(81.71±8.12)%and(65.15±4.02)mm Hg of the control group,and the PaCO_(2)(40.61±3.52)mm Hg was lower than(55.32±4.65)mm Hg of the control group.All the difference was statistically significant(P<0.05).The total effective rate of the research group was 91.43%(32/35),which was obviously higher than 68.57%(24/35)of the control group,and the difference was statistically significant(P<0.05).Before treatment,there was no statistically significant difference in levels of IL-6 and IL-8 between the two groups(P>0.05).After treatment,the IL-6 and IL-18 of the research group were(14.53±2.08)and(252.64±67.43)ng/ml,which were significantly lower than(20.71±3.15)and(293.08±62.48)ng/ml of the control group,and the difference was statistically significant(t=9.686,2.603;P=0.000,0.011<0.05).Conclusion Combination of noninvasive-invasive sequential ventilation and atomization inhalation helps improve the pulmonary function of elderly patients with patients with severe asthma and type Ⅱ respiratory failure,stable blood gas indexes,thus improving prognosis of patients.