慢性阻塞性肺疾病合并心力衰竭患者酚妥拉明辅助无创正压通气治疗前后血气分析指标及血清免疫炎性因子监测的意义

Significance of monitoring blood gas indexes and serum immune inflammatory factors before and after phentolamine assisted non-invasive positive pressure ventilation in patients with chronic obstructive pulmonary disease complicated with heart failure

目的:研究酚妥拉明辅助无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)合并心力衰竭(HF)的临床效果及治疗前后血气分析指标、血清免疫炎性因子水平监测的意义。方法:前瞻性选取南京中医药大学附属常州市中医医院98例COPD合并HF患者,均符合纳入、排除标准,依据简单随机数字表法将所有患者分为两组,各49例,其中一组接受NIPPV治疗设为对照组,另一组在NIPPV治疗基础上加用酚妥拉明设为观察组。比较两组治疗前后的血气分析指标,同时依据COPD合并HF患者的肺功能分级,对比治疗前后不同病情下的血清学指标变化。结果:两组治疗前不同肺功能分级间的IL-17A、CD3^(+)、CD4^(+)及PCT水平相比差异均无统计学意义(均P>0.05)。观察组肺功能Ⅲ级的IL-17A、PCT水平高于Ⅰ级(t=4.595、7.734,均P=0.001);观察组肺功能Ⅲ级的CD3^(+)、CD4^(+)水平低于Ⅰ级(t=4.303、5.596,均P=0.001)。治疗7 d后,观察组肺功能Ⅲ、Ⅱ、Ⅰ级的IL-17A水平分别(44.63±5.21)ng·L^(-1)、(39.25±6.14)ng·L^(-1)、(33.44±4.85)ng·L^(-1)低于对照组(47.52±5.96)ng·L^(-1)、(42.52±6.22)ng·L^(-1)、(37.52±6.20)ng·L^(-1)(t=5.480、2.073、2.271,P=0.001、0.046、0.029);观察组肺功能Ⅲ、Ⅱ、Ⅰ级的PCT水平分别(10.15±2.74)μg·L^(-1)、(8.11±1.49)μg·L^(-1)、(4.68±1.41)μg·L^(-1)低于对照组(12.47±2.17)μg·L^(-1)、(10.11±1.39)μg·L^(-1)、(6.55±1.74)μg·L^(-1)(t=2.316、2.507、3.656,P=0.030、0.017、0.001);观察组肺功能Ⅲ、Ⅱ、Ⅰ级的CD3^(+)水平分别(51.63±4.60)%、(59.63±4.33)%、(63.52±4.66)%高于对照组(47.85±4.20)%、(56.52±4.52)%、(60.25±4.85)%(t=2.104、2.108、2.119,P=0.047、0.042、0.041);观察组肺功能Ⅲ、Ⅱ、Ⅰ级的CD4^(+)水平分别(29.66±3.89)%、(33.20±4.56)%、(38.98±4.66)%高于对照组(24.86±4.27)%、(28.52±4.24)%、(34.52±4.58)%(t=2.061、2.507、2.970,P=0.034、0.017、0.005)。观察组Ⅲ级的IL-17A、PCT水平高于Ⅱ级、Ⅰ级,差异有统计学意义(t_(IL-17A)=2.712、5.641,P_(IL-17A)=0.009、0.001;t_(PCT)=2.990、8.017,P_(PCT)=0.004、0.001);对照组Ⅲ级的CD3^(+)、CD4^(+)水平低于Ⅱ级、Ⅰ级(t_(CD3^(+))=2.743、9.631,P_(CD3^(+))=0.008、0.001;t_(CD4^(+))=2.194、5.775,P_(CD4^(+))=0.033、0.001)。结论:酚妥拉明联合NIPPV治疗,可明显促进COPD合并HF患者血清学指标改善,利于呼吸功能及机体恢复。

Objective:To study the clinical effect of phentolamine assisted non-invasive positive pressure ventilation(NIPPV)in the treatment of chronic obstructive pulmonary disease(COPD)complicated with heart failure(HF)and the significance of monitoring blood gas indexes and serum immune inflammatory factors before and after treatment.Methods:The clinical data of 98 patients with COPD complicated with HF treated in our hospital were prospectively selected.All patients met the inclusion and exclusion criteria.According to the simple random number table method,all patients were divided into two groups,with 49 in each.The patients in the control group received NIPPV treatment and those in the observation group with phentolamine on the basis of NIPPV treatment.The blood gas indexes of the two groups before and after treatment were compared.At the same time,according to the pulmonary function classification of COPD patients with HF,the changes of serological indexes under different conditions before and after treatment were compared.Results:There was no significant difference in the levels of IL-17A,CD3^(+),CD4^(+)and PCT between the two groups before treatment(P>0.05).The levels of IL-17A and PCT in grade Ⅲ of pulmonary function in the observation group were higher than those in gradeⅠ(t=4.595,7.734,all P=0.001).The levels of CD3^(+)and CD4^(+)in lung function grade Ⅲ of the observation group were lower than those in grade Ⅰ (t=4.303,5.596,all P=0.001).After 7 days of treatment,the levels of IL-17 A in lung functionⅢ,Ⅱ and Ⅰ in the observation group were(44.63±5.21)ng·L^(-1),(39.25±6.14)ng·L^(-1) and(33.44±4.85)ng·L^(-1),respectively,which were lower than those in the control(47.52±5.96)ng·L^(-1),(42.52±6.22)ng·L^(-1) and(37.52±6.20)ng·L^(-1)(t=5.480,2.073,2.271,P=0.001,0.046,0.029).The PCT levels of lung function grade Ⅲ,Ⅱ and Ⅰ in the observation group were(10.15±2.74)μg·L^(-1),(8.11±1.49)μg·L^(-1) and(4.68±1.41)μg·L^(-1),respectively,which were lower than those in the control(12.47±2.17)μg·L^(-1),(10.11±1.39)μg·L^(-1) and(6.55±1.74)μg·L^(-1)(t=2.316,2.507,3.656,P=0.030,0.017,0.001).The CD3^(+)levels of lung function grade Ⅲ,Ⅱ and Ⅰ in the observation group were(51.63±4.60)%,(59.63±4.33)%and(63.52±4.66)%,respectively,which were higher than those in the control(47.85±4.20)%,(56.52±4.52)%and(60.25±4.85)%(t=2.104,2.108,2.119,P=0.047,0.042,0.041).The CD4^(+)levels of lung function grade Ⅲ,Ⅱ and Ⅰ in the observation group were(29.66±3.89)%,(33.20±4.56)%and(38.98±4.66)%,respectively,which were higher than those in the control(24.86±4.27)%,(28.52±4.24)%and(34.52±4.58)%(t=2.061,2.507,2.970,P=0.034,0.017,0.005).The levels of IL-17 A and PCT in grade Ⅲ in the observation group were higher than those in grade Ⅱ and grade Ⅰ,and the differences were statistically significant(t_(IL-17A)=2.712,5.641,P_(IL-17A)=0.009,0.001;t_(PCT)=2.990,8.017,P_(PCT)=0.004,0.001).In the control group,the levels of CD3^(+)and CD4^(+)in grade Ⅲ were lower than those in grade Ⅱ and grade I(t_(CD3^(+))=2.743,9.631,P_(CD3^(+))=0.008,0.001;t_(CD4^(+))=2.194,5.775,P_(CD4^(+))=0.033,0.001).Conclusion:The treatment with phentolamine combined with NIPPV can significantly promote the improvement of serological indicators in patients with COPD and HF,which is conducive to the recovery of respiratory function and body.