糖皮质激素联合无创正压通气治疗AECOPD的效果及对肌力情况、肌痛的影响

Effect of Glucocorticoid Combined with Non Invasive Positive Pressure Ventilation in the Treatment of AECOPD and the Influence on Muscle Strength and Myalgia

目的探讨糖皮质激素联合无创正压通气(NIPPV)治疗AECOPD的效果及对肌力情况、肌痛的影响。方法选取2017年8月至2019年8月我院收治的AECOPD患者240例,随机分为观察组和对照组各120例。对照组采用糖皮质激素治疗,观察组在此基础上采用NIPPV治疗。比较两组的血气分析结果、治疗有效率、肌力评分、肌痛、肌电图、血CK及尿肌酸水平。结果治疗后,观察组的pH达标率、PaO_(2)达标率、PaCO_(2)达标率、SpO_(2)达标率和治疗有效率均高于对照组(P<0.05);观察组肌力评分3级比例低于对照组,肌力评分5级比例高于对照组(P<0.05);观察组肌痛发生率低于对照组(P<0.05)。两组患者治疗前后的血CK、尿肌酸水平比较差异无统计学意义(P>0.05)。结论糖皮质激素联合NIPPV治疗AECOPD可有效减少由糖皮质激素引发的肌力下降及肌痛等副作用,降低激素诱发类固醇肌病的风险。

Objective To explore the effect of glucocorticoid combined with non invasive positive pressure ventilation(NIPPV)in the treatment of AECOPD and the influence on muscle strength and myalgia.Methods 240 AECOPD patients admitted to our hospital from August 2017 to August 2019 were selected and randomly divided into observation group and control group,with 120 cases in each group.The control group was treated with glucocorticoid,and the observation group was treated with NIPPV on this basis.The blood gas analysis results,effective rate of treatment,muscle strength score,myalgia,electromyogram,blood CK and urine creatine levels were compared between the two groups.Results After treatment,the pH compliance rate,PaO_(2) compliance rate,PaCO_(2) compliance rate,SpO_(2) compliance rate and treatment effective rate of the observation group were higher than those of the control group(P<0.05);The rate of muscle strength score grade 3 in the observation group was lower than that in the control group,and the rate of muscle strength score grade 5 was higher than that in the control group(P<0.05);The incidence of myalgia in the observation group was lower than that in the control group(P<0.05).No statistical difference was found in the serum CK and urine creatine levels before and after treatment between the two groups(P>0.05).Conclusions Glucocorticoid combined with NIPPV in the treatment of AECOPD can effectively reduce the side effects such as decreased muscle strength and myalgia caused by glucocorticoid,and reduce the risk of steroid-induced myopathy.