气道激素雾化吸入联合前列地尔治疗老年AECOPD合并肺动脉高压患者的临床研究

Clinical trial of airway hormone atomization inhalation combined with alprostadil in the treatment of elderly patients with AECOPD complicated with pulmonary hypertension

目的探究气道激素雾化吸入联合前列地尔治疗老年慢性阻塞性肺疾病急性加重期(AECOPD)合并肺动脉高压(PH)患者疗效及对血气指标、血流动力学和炎症因子的影响。方法将老年AECOPD合并PH患者随机分为对照组和试验组,2组均实施常规治疗,对照组在常规治疗基础上给予雾化吸入吸入用布地奈德混悬液1 mg(bid)和硫酸沙丁胺醇溶液2.5 mL(qid),试验组在对照组基础上给予雾化吸入前列地尔注射液0.2μg·kg^(-1),2组均治疗2周,比较2组临床疗效及治疗前与治疗2周后肺功能[一秒钟用力呼气容积(FEV1)、肺活量(FVC)、FEV1/FVC]、血气指标[氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))]、血流动力学指标、炎症因子指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、肺血管功能指标[肺血管顺应性(Cpv)、肺血管总阻力(TPR)]及药物不良反应发生情况。结果试验过程中共脱落3例,最终试验组和对照组均纳入56例。治疗后,试验组和对照组的总有效率分别为94.64%(53例/56例)和78.57%(44例/56例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组的FEV1/FVC分别为(76.45±9.10)%和(72.54±7.62)%;PaO_(2)分别为(70.52±11.39)和(59.63±9.40)mmHg;SaO_(2)分别为(89.46±16.03)%和(81.15±14.27)%;Cpv分别为(29.95±5.72)和(26.74±3.90)mL·kPa-1;血浆黏度分别为(1.16±0.10)和(1.63±0.18)mPa·s;血小板聚集率分别为(22.40±4.33)%和(30.28±6.07)%;TNF-α表达水平分别为(5.14±1.12)和(12.60±3.18)mg·L^(-1);CRP表达水平分别为(8.27±2.03)和(17.20±3.19)ng·L^(-1);IL-6表达水平分别为(4.22±0.78)和(9.50±2.66)ng·L^(-1)。试验组上述指标与对照组比较,差异均有统计学意义(均P<0.05)。试验组和对照组的总药物不良反应发生率分别为10.71%和8.93%,差异无统计学意义(P>0.05)。结论气道激素雾化吸入联合前列地尔比单纯气道激素雾化吸入治疗老年AECOPD合并PH患者的疗效更佳,可改善肺功能、血气指标、血流动力学及肺血管功能,降低炎症因子,且安全性较高。

Objective To explore the efficacy of airway hormone atomization inhalation combined with alprostadil in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pulmonary hypertension(PH)and its effects on blood gas indexes,hemorheology and inflammatory factors.Methods The elderly patients with AECOPD combined with PH were randomly divided into control group and treatment group.Both groups were given routine treatment.The control group was given budesonide suspension for atomization inhalation 1 mg(bid)and salbutamol sulfate solution 2.5 mL(qid)on the basis of routine treatment.The treatment group was given nebulized intravenous infusion of alprostadil injection 0.2μg·kg^(-1) on the basis of the control group.Both groups were treated for 2 weeks.The clinical efficacy,lung function[forced expiratory volume in one second(FEV1),FEV1/FVC],blood gas index[partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygen saturation(SaO_(2))],hemorheology index,inflammatory factor index[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)],pulmonary vascular function index[pulmonary vascular compliance(Cpv),total pulmonary vascular resistance(TPR)]and adverse drug reactions were compared between the two groups before and after 2 weeks of treatment.Results A total of 3 cases were lost during the trial,and finally 56 cases were included in the treatment group and the control group,respectively.After treatment,the clinical efficacies in the treatment group and control group were 94.64%(53 cases/56 cases)and 78.57%(44 cases/56 cases),respectively,and there was difference between two groups(P<0.05).After treatment,the FEV1/FVC in the treatment group and the control group were(76.45±9.10)%and(72.54±7.62)%,respectively;PaO_(2) were(70.52±11.39)and(59.63±9.40)mmHg,respectively;SaO_(2) were(89.46±16.03)%and(81.15±14.27)%,respectively;Cpv were(29.95±5.72)and(26.74±3.90)mL·kPa-1,respectively;the plasma viscosity was(1.16±0.10)and(1.63±0.18)mPa·s,respectively;the platelet aggregation rates were(22.40±4.33)%and(30.28±6.07)%,respectively;the expression levels of TNF-αwere(5.14±1.12)and(12.60±3.18)mg·L^(-1),respectively;the expression levels of CRP were(8.27±2.03)and(17.20±3.19)ng·L^(-1),respectively;the levels of IL-6 were(4.22±0.78)and(9.50±2.66)ng·L^(-1),respectively.There were significant differences in the above indexes between the treatment group and the control group(all P<0.05).The total incidence of adverse drug reactions in the treatment group and the control group was 10.71%and 8.93%,respectively,the difference was not statistically significant(P>0.05).Conclusion Compared with simple aerosol inhalation of hormones,aerosol inhalation of hormones combined with alprostadil is more effective in the treatment of elderly patients with AECOPD and PH as it can improve pulmonary function,blood gas indexes,hemorheology and pulmonary vascular function,and reduce inflammatory factors,with higher safety.