布地奈德福莫特罗、异丙托溴铵联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭老年患者的临床研究

Clinical trial of budesonide formoterol,ipratropium bromide combined with NIPPV in the treatment of elderly patients with COPD complicated with type Ⅱ respiratory failure

目的 分析研究布地奈德福莫特罗、异丙托溴铵联合无创正压通气(NIPPV)治疗方案在慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭老年患者的实际治疗效果。方法 入选符合COPD合并Ⅱ型呼吸衰竭临床诊断的患者。对照组治疗方式为NIPPV式吸氧,每次3~4 h,tid,共治疗28 d,试验组在NIPPV式吸氧治疗基础上接受布地奈德福莫特罗吸入粉雾剂1吸和异丙托溴铵溶液2 mL雾化吸入,bid,持续3 d为1个周期,周期间隔4 d,共执行4个周期累计28 d。观察2组患者治疗前后动脉血二氧化碳分压(PaCO_(2))、肺功能指标一秒用力呼气容积/用力肺活量(FEV1/FVC)、六分钟步行实验距离、BODE指数等指标变化。结果 本研究共入组115例,其中对照组58例,试验组57例。治疗结束后,试验组与对照组FEV1/FVC分别为(65.12±5.11)%和(60.12±1.43)%,PaCO_(2)分别为(36.99±3.28)和(40.05±1.46)mmHg,六分钟步行距离分别为(459.15±17.25)和(400.15±25.16) m,BODE指数分别为3.00±0.42和3.81±0.28,1年期的总体生存率分别为(88.14±12.16)%和(71.14±11.14)%,肺功能改善率分别为73.68%(42例/57例)和58.62%(34例/58例);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)。试验组与对照组的药物不良反应发生率分别为21.05%(12例/57例)和18.97%(11例/58例),差异无统计学意义(P>0.05)。结论 布地奈德福莫特罗、异丙托溴铵联合NIPPV的治疗方案能明显改善COPD合并Ⅱ型呼吸衰竭患者运动耐力,可显著降低BODE指数,并延缓1年内全因死亡事件发生。

Objective To analyze and study the actual therapeutic effect of the combined treatment of budesonide-formoterol and ipratropium bromide with non-invasive positive pressure ventilation(NIPPV) in elderly patients with chronic obstructive pulmonary disease(COPD) and type Ⅱ respiratory failure.Methods Patients diagnosed clinically with COPD and type Ⅱ respiratory failure were selected for the study.The control group received NIPPV-style oxygen therapy for 3-4 hours each time,tid,for a total of 28 days,while the treatment group received budesonide-formoterol inhalation powder 1 inhalation and ipratropium bromide solution 2 mL aerosol inhalation on the basis of control group,twice a day for three consecutive days,for a total of four treatment cycles,with a cycle interval of 4 days and a total treatment duration of 28 days.Changes in arterial carbon dioxide partial pressure(PaCO_(2)),the ratio of forced expiratory volume in one second to forced vital capacity(FEV1/FVC),6-minute walk test distance,BODE index,and other indicators were observed before and after treatment in the two groups.Results A total of 115 patients were included in the study,including 58 in the control group and 57in the treatment group.After treatment,the FEV1/FVC in the treatment group and the control group were(65.12±5.11) % and(60.12±1.43) %,respectively;PaCO_(2) were(36.99±3.28) and(40.05±1.46) mmHg,respectively;6-minute walk test distances were(459.15±17.25) and(400.15±25.16) m,respectively;BODE index were 3.00±0.42 and 3.81±0.28,respectively.The overall survival rates in the two groups after 1 year were(88.14±12.16) % and(71.14±11.14)%,respectively,and the rates of improvement in lung function were 73.68%(42 cases/57 cases) and 58.62%(34 cases/58 cases),respectively.The differences in these indicators between the two groups were statistically significant(all P <0.05).The incidence of drug adverse reactions in the treatment group and the control group were 21.05%(12 cases/57 cases) and 18.97%(11 cases/58 cases),respectively,without significant difference(P> 0.05).Conclusion The combined treatment of budesonide-formoterol and ipratropium bromide with NIPPV can significantly improve the exercise tolerance of patients with COPD and type Ⅱ respiratory failure.It can also significantly reduce BODE index and delay the occurrence of all-cause mortality events within 1 year.