无创呼吸机辅助治疗对慢性阻塞性肺疾病合并呼吸衰竭患者呼吸力学和炎症指标的影响

Effects of noninvasive positive pressure ventilation assisted therapy on respiratory mechanics and inflammatory indexes in patients with chronic obstructive pulmonary disease complicated by respiratory failure

目的探究无创呼吸机(NPPV)辅助治疗对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者呼吸力学和炎症指标的影响。方法抽取2020年6月到2022年12月驻马店中心医院收治的COPD合并呼吸衰竭患者160例,采用随机数字表法分为研究组和对照组,每组80例。研究组采用NPPV辅助治疗,对照组仅采用传统治疗。比较两组治疗前后的血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))及pH值]、呼吸力学指标[吸入氧浓度(FiO_(2))、吸气峰压(PIP)及吸气与呼吸周期时间比(Ti/Ttot)]、肺功能[肺活量(VC)、残气量(RV)、肺总容量(TLC)]及炎症指标[白细胞计数(WBC)、高敏C反应蛋白(hs-CRP)、白细胞介素-16(IL-16)及白细胞介素-18(IL-18)]。结果治疗14 d后,两组pH值、PaO_(2)均高于治疗前,PaCO_(2)均低于治疗前(P均<0.05);治疗后,研究组PaO_(2)高于对照组,PaCO_(2)低于对照组(P<0.05)。治疗14 d后,两组FiO_(2)、PIP均低于治疗前,且研究组低于对照组(P<0.05);治疗后,两组Ti/Ttot均高于治疗前,且研究组高于对照组(P<0.05)。治疗14 d后,两组VC均高于治疗前,且研究组高于对照组(P<0.05);RV、TLC均低于治疗前,且研究组低于对照组(P<0.05)。治疗14 d后,两组血清WBC、hs-CRP、IL-6、IL-18水平均低于治疗前,且研究组低于对照组(P<0.05)。结论在COPD合并呼吸衰竭患者中,NPPV辅助治疗可以改善患者的动脉血气指标和呼吸机参数,同时可以降低炎症指标的水平,减轻炎症反应。

ObjectiveTo investigate the effect of noninvasive positive pressure ventilation(NPPV)on respiratory mechanics and inflammatory indexes in patients with chronic obstructive pulmonary disease(COPD)complicated by respiratory failure.MethodsA total of 160 patients with COPD complicated by respiratory failure admitted to Zhumadian Central Hospital from June 2020 to December 2022 were selected,and they were divided into study group and control group by random number table method,with 80 cases in each group.Patients in the study group were treated by NPPV,while patients in the control group only received traditional treatment.The blood gas analysis indicators,including arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2))and potential hydrogen(pH)value,respiratory mechanics indicators,including fractional concentration of inspired oxygen(FiO_(2)),peak inspiratory pressure(PIP),and inspiratory time with total inspiratory and expiratory time(Ti/Ttot),lung function assessed by vital capacity(VC),residual volume(RV)and total lung capacity(TLC),and inflammatory indicators,including white blood cell count(WBC),high sensitivity C-reactive protein(hs-CRP),interleukin-16(IL-16)and interleukin-18(IL-18),were compared between the two groups before and after treatment.ResultsAfter 14 days of treatment,the pH value and PaO_(2)of the two groups were higher than those before treatment,while PaCO_(2)of the two groups were lower than those before treatment(all P<0.05);after treatment,PaO_(2)in the study group was higher than that in the control group,and PaCO_(2)was lower than that in the control group(P<0.05).After 14 days of treatment,FiO_(2)and PIP in the two groups were lower than those before treatment,and the two indexes in the study group were lower than those in the control group(P<0.05).After treatment,Ti/Ttot in the two groups were higher than those before treatment,and Ti/Ttot in the study group was higher than that in the control group(P<0.05).After 14 days of treatment,VC levels in the two groups were higher than those before treatment,and the VC level in study group was higher than that in the control group(P<0.05);RV and TLC in the two groups were lower than those before treatment,while RV and TLC in the study group were lower than those in the control group(P<0.05).After 14 days of treatment,the levels of WBC,hs-CRP,IL-6 and IL-18 in the two groups were lower than those before treatment,and the indexes in the study group were lower than those in the control group(P<0.05).ConclusionsIn COPD patients with respiratory failure,NPPV can improve the arterial blood gas and ventilation parameters,reduce the levels of inflammatory indexes,and alleviate the inflammatory response.