噻托溴铵联合无创正压通气治疗慢性阻塞性肺疾病并呼吸衰竭的临床观察

Clinical observation on the efficacy of tiotropium bromide combined with NIPPV in the treatment of COPD complicated with respiratory failure

目的探讨噻托溴铵联合无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)并呼吸衰竭的临床效果。方法将2019年6月至2021年4月徐州医科大学附属沭阳医院收治的70例COPD并呼吸衰竭患者作为研究对象,以随机抽签的方法将其分为对照组(常规治疗+NIPPV治疗,n=35)、观察组(对照组方案联合噻托溴铵吸入治疗,n=35),观察比较两组临床相关指标、肺功能指标、血气指标。结果观察组插管率为5.71%,与对照组的11.43%比较,差异无统计学意义(P>0.05),且观察组住院时间(15.42±2.08)d短于对照组,COPD严重程度评分(15.33±2.54)分显著低于对照组,6 min步行距离(362.22±46.98)m显著长于对照组,差异有统计学意义(P<0.05);观察组治疗后第1秒用力呼气容积(FEV_(1))为(1.71±0.37)L、用力肺活量(FVC)为(2.29±0.38)L以及第1秒用力呼气量占所有呼气量的比例(FEV_(1)/FVC)为(83.03±10.07)%,均显著高于对照组,差异有统计学意义(P<0.05);观察组动脉血氧分压(PaO_(2))为(89.03±9.15)mmHg、氧合指数(PaO_(2)/FIO_(2))为(409.71±21.48)mmHg、血氧饱和度(SaO_(2))为(96.02±3.25)%,均显著高于对照组,且动脉血二氧化碳分压(PaCO_(2))为(47.37±5.06)mmHg,显著低于对照组,差异有统计学意义(P<0.05)。结论噻托溴铵联合NIPPV治疗COPD并呼吸衰竭的临床效果突出,对患者肺功能和血气指标均有较好的改善效果。

Objective To investigate the clinical efficacy of tiotropium bromide combined with non-invasive positive pressure ventilation(NIPPV)in the treatment of chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods A total of 70 patients with COPD and respiratory failure admitted to the Affiliated Shuyang Hospital of Xuzhou Medical University from June 2019 to April 2021 were selected as study subjects,and they were equally divided into the control group(n=35,conventional treatment+NIPPV)and the observation group(n=35,the treatment scheme of the control group+tiotropium bromide inhalation)by random drawing method.The relevant clinical indicators,pulmonary function indicators,and blood-gas indicators were observed and compared between the two groups.Results There was no statistically significant difference between the observation group(5.71%)and the control group(11.43%)in the intubation rate(P>0.05).The length of hospital stay(15.42±2.08)d was shorter,the COPD severity score(15.33±2.54)was significantly lower and the 6-min walking distance(362.22±46.98)m was significantly longer in the observation group than that in the control group,respectively,with statistically significant differences(P<0.05).The forced expiratory volume in one second(FEV_(1))(1.71±0.37)L,forced vital capacity(FVC)(2.29±0.38)L and FEV_(1)/FVC(83.03±10.07)%in the observation group were significantly higher than those in the control group after treatment,with statistically significant differences(P<0.05).The arterial partial pressure of oxygen(PaO_(2))(89.03±9.15)mmHg,PaO_(2)/fraction of inspiration O_(2)(FIO_(2))(409.71±21.48)mmHg and blood oxygen saturation(SaO_(2))(96.02±3.25)%were significantly higher,and the arterial partial pressure of carbon dioxide(PaCO_(2))(47.37±5.06)mmHg was significantly lower in the observation group than those in the control group,with statistically significant differences(P<0.05).Conclusion The combination of tiotropium bromide and NIPPV is of outstanding clinical efficacy in the treatment of COPD complicated with respiratory failure,and has a good effect on the pulmonary function and bl ood-gas indicators of the patients.