低分子量肝素钙联合沙丁胺醇雾化吸入及无创正压通气治疗COPD急性加重合并Ⅱ型呼吸衰竭的疗效

Efficacy of low molecular weight heparin calcium combined with salbutamol inhalation and noninvasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease with type Ⅱ respiratory failure

目的观察低分子量肝素钙联用沙丁胺醇雾化吸入与无创正压通气(non-invasive positive pressure ventiladion,NIPPV)联合治疗急性加重期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床疗效。方法选取2016年1月至2021年1月西南医科大学附属医院呼吸内科收治的90例慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭病人作为研究对象,按照治疗方式将病人分为对照组和实验组,每组各45例。对照组的病人在常规治疗的基础上给予沙丁胺醇雾化吸入及NIPPV治疗,实验组在对照组基础上加用低分子量肝素钙治疗,两组连续治疗一个周期(14 d)。对比两组病人治疗前后血常规、动脉血气分析、肺功能、凝血功能指标,PASP、ET-1、hs-CRP、NT-proBNP水平变化,以及无创机械通气的时间、住院的总时间和不良反应的发生情况。结果(1)治疗前对照组、实验组病人HCT、Hb、PLT及RBC值,差异无统计学意义(P>0.05);治疗后对照组的水平低于实验组,差异有统计学意义(P<0.05)。(2)两组病人PaO_(2)、PaCO_(2)、pH值、SaO_(2),治疗前差异没有统计学意义(P>0.05);治疗后实验组病人PaO_(2)、pH值、SaO_(2)高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。(3)两组病人FEV_(1)/FVC和PEF,治疗前差异无统计学意义(P>0.05);治疗后对照组病人FEV_(1)/FVC和PEF高于实验组(P<0.05)。(4)两组病人ATPP、PT、TT、Fib、D-D值,治疗前差异没有统计学意义(P>0.05),治疗后实验组的病人ATPP、PT、TT、Fib、D-D的水平低于对照组,差异有统计学意义(P<0.05)。(5)两组病人hs-CRP、PASP、NT-proBNP和ET-1值,治疗前差异无统计学意义(P>0.05),治疗后实验组低于对照组(P<0.05)。(6)对照组病人无创机械通气时间、住院时间短于实验组(P<0.05)。(7)两组病人不良反应发生率,差异无统计学意义(P>0.05)。结论低分子量肝素钙联用沙丁胺醇雾化吸入与无创正压通气治疗慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭的疗效确切,安全性高,可推广用于临床治疗。

Objective To observe the clinical efficacy of low-molecular-weight heparin calcium combined with aerosol inhala⁃tion of salbutamol and non-invasive positive pressure ventilation(NIPPV)in the treatment of acute exacerbation of chronic obstructive pulmonary disease with type Ⅱ respiratory failure.Methods From January 2016 to January 2021,90 patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with type Ⅱ respiratory failure treated in the Department of Respiratory Medicine,Affiliated Hospital of Southwest Medical University were selected as the research subjects.According to the treatment methods,patients were divided into control group and experimental group,with 45 cases in each group.Patients in control group were treated with salbutamol inhalation and NIPPV on the basis of conventional treatment,while the experimental group was treated with low molecular-weight heparin calcium on the basis of control group,and the two groups were treated continuously for one cycle(14 days).The changes of blood routine,arterial blood gas analysis,lung function,coagulation function indexes,PASP,ET-1,hs-CRP,NTproBNP,as well as the time of non-invasive mechanical ventilation,the total length of hospitalization and the occurrence of adverse re⁃actions were compared between the two groups before and after treatment.Results(1)There was no significant difference in HCT,Hb,PLT and RBC before treatment in the control group(P>0.05).After treatment,the levels of control group were lower than that of experi⁃mental group,with statistically significant differences(P<0.05).(2)Comparing PaO_(2),PaCO_(2),pH and SaO_(2)between the two groups,there were no statistically significant differences before treatment(P>0.05).After treatment,PaO_(2),pH and SaO_(2)of the experimental group were higher than the control group,and PaCO_(2)was lower than the control group,with statistically significant differences(P<0.05).(3)Comparing the FEV1/FVC and PEF between the two groups,the results showed that the difference before treatment was not sta⁃tistically significant(P>0.05);after treatment,the FEV1/FVC and the PEF of the control group were higher than these of the experi⁃mental group(P<0.05).(4)The ATPP,PT,TT,Fib and D-D values of the two groups were compared,and there were no significant dif⁃ferences before treatment(P>0.05).After treatment,the levels of ATPP,PT,TT,Fib and D-D in experimental group were lower than those in control group,and the differences were statistically significant(P<0.05).(5)The levels of hs-CRP,PASP,NT-proBNP and ET-1were compared,there were no significant differences before treatment(P>0.05),but after treatment,the values of experimental group were lower than control group,and the differences were statistically significant(P<0.05).(6)The duration of non-invasive mechanical ventilation and hospital stay in the control group were shorter than those in the experimental group(P<0.05).(7)Comparing the incidence of adverse reactions among patients,the difference was not statistically significant(P>0.05).Conclusion Low-molecularweight heparin calcium combined with aerosol inhalation of salbutamol and non-invasive positive pressure ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease with type 2 respiratory failure has definite curative effect,high safety,and can be promoted for clinical treatment.