无创机械通气对AECOPD合并高碳酸血症患者治疗前后炎症状态及T淋巴细胞亚群的影响

Influence ofnon-invasive mechanical ventilation on inflammatory state and T lymphocyte subsets in patients with AECOPD complicated with hypercapnia before and after treatment

目的:观察无创机械通气对慢性阻塞性肺疾病急性加重(AECOPD)合并高碳酸血症患者治疗前后炎症状态及T淋巴细胞亚群的影响。方法:选取2018年3月至2020年2月我院收治的AECOPD合并高碳酸血症患者60例,采用随机数字表法分为两组,每组30例,对照组予以氧疗与常规药物治疗,观察组在对照组基础上予以无创机械通气治疗,比较两组治疗前后炎症状态[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素8(IL-8)]、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、血气指标[pH值、动脉血二氧化碳分压(PaCO_(2))与氧分压(PaO_(2))],并观察两组恢复进程(好转时间与住院时间)及并发症情况。结果:经1周治疗,观察组血清TNF-α、IL-6、IL-8浓度低于对照组(P<0.05),CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组(P<0.05);两组治疗前与治疗24 h后pH值比较无明显差异(P>0.05);两组治疗24 h后动脉血PaCO_(2)明显降低(P<0.05),PaO_(2)明显升高(P<0.05),但组间比较无明显差异(P>0.05);观察组好转时间、住院时间明显短于对照组(P<0.05);两组并发症发生率比较无明显差异(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,可更好改善其炎症与T淋巴细胞亚群状态,缩短住院时间,且应用安全。

Objective:To observe the influence ofnon-invasive mechanical ventilation on inflammatory state and T lymphocyte subsets in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and hypercapnia before and after treatment.Methods:Sixty patients with AECOPD and hypercapnia who were admitted to ourhospital from March 2018 to February 2020 were selected,and were randomly divided into a control group and an observation group,with 30 patients in each group.The patients in the control group receivedoxygen therapy and conventional medical treatment,and those in the observation group were treated as the control group with addition of non-invasive mechanical ventilation.The inflammatory cytokines such as tumor necrosis factor-α(TNF-α),interleukin-6(IL)-6 and IL-8,T lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),and bloodgas indexesincluding pH value,arterial partial pressure of carbon dioxide(PaCO_(2))and partial pressure of oxygen(PaO_(2))were compared between the 2 groups before and after treatment.The recovery time,hospital days and complicationswere recorded.Results:After 1 week of treatment,the levels of serum TNF-α,IL-6 and IL-8 were significantly lower in the observation group than those in the control group,while the levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) were significantly higher(P<0.05).The pH valueof the 2 groups showed no significant differences before treatment and after 24 hours of treatment(P>0.05).PaCO_(2) was significantlyreduced(P<0.05),and PaO_(2)was significantly increased in the 2 groups after 24 hours of treatment(P<0.05).However,there was no significant difference between the two groups(P>0.05).The recovery time and hospital days inthe observation group weresignificantly shorter than thosein the control group(P<0.05).There was no significant difference in the incidence of complications between the twogroups(P>0.05).Conclusion:Non-invasive mechanical ventilation for patients with AECOPD complicated with hypercapnia can better improve inflammatory state and T lymphocyte subsets,and shorten hospital days,and it was safe.