BiPAP联合经管道雾化吸入糖皮质激素治疗AECOPD合并Ⅱ型呼吸衰竭的疗效及对肺动脉压力和外周血EOS水平的影响

Effect of bilevel positive airway pressure combined with aerosol inhalation of glucocorticoids via pipelines in treating AECOPD complicated with type Ⅱ respiratory failure and the impact on pulmonary artery pressure and peripheral blood EOS level

目的 探究双水平正压通气(BiPAP)联合经管道雾化吸入糖皮质激素(GC)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭(T2RF)的疗效及对患者肺动脉压力(PAP)和外周血嗜酸性粒细胞(EOS)水平的影响。方法 选取2022年4月至2023年4月陕西省康复医院收治的80例AECOPD合并T2RF患者为研究对象,依据随机数表法分为接受BiPAP治疗的对照组(40例)和接受BiPAP联合经管道雾化吸入GC治疗的观察组(40例),两组均治疗2周。比较两组患者的临床疗效以及治疗前后的肺功能、血气指标和炎症指标,并评估治疗期间两组患者的不良反应发生情况。结果 观察组患者的治疗总有效率为97.50%,明显高于对照组的80.00%,差异具有统计学意义(P<0.05);治疗后,观察组患者的用力肺活量(FVC)、第一秒用力呼吸气容积(FEV_(1))分别为(1.99±0.53) L、(2.55±0.45) L,明显高于对照组的(1.72±0.46) L、(2.11±0.52) L,差异均有统计学意义(P<0.05);治疗后,观察组患者的氧分压(PaO_(2))为(85.34±12.39) mmHg,明显高于对照组的(71.43±11.87) mmHg,二氧化碳分压(PaCO_(2))为(60.11±8.35) mmHg,明显低于对照组的(69.06±9.84) mmHg,差异均有统计学意义(P<0.05);治疗后,观察组患者的白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)和EOS水平分别为(42.37±5.72) ng/L、(23.71±5.21) ng/L、(4.53±1.13)%,明显低于对照组的(51.19±6.37) ng/L、(32.63±6.01) ng/L、(8.46±2.14)%,差异均有统计学意义(P<0.05);治疗期间,观察组患者的不良反应总发生率为10.00%,略高于对照组的5.00%,但差异无统计意义(P>0.05)。结论 BiPAP联合经管道雾化吸入GC治疗AECOPD合并T2RF可明显改善患者的肺功能指标、血气和炎症状态,临床应用效果显著且安全性较高,具有临床应用价值。

Objective To investigate the effect of bilevel positive airway pressure (BiPAP) combined with aerosol inhalation of glucocorticoids (GC) via pipelines in treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type Ⅱ respiratory failure (T2RF),and the impact on pulmonary artery pressure(PAP) and peripheral blood eosinophil (EOS) level.Methods A total of 80 patients with AECOPD and T2RF who were admitted to Shaanxi Provincial Rehabilitation Hospital from April 2022 to April 2023 were selected as the study subjects.They were divided into the control group (40 patients treated with BiPAP) and the observation group (40 patients treated with BiPAP combined with aerosol inhalation of GC via pipelines) by the random number table method.Both groups were treated for 2 weeks.The two groups were compared on clinical effects,pulmonary function,blood gas indicators,and inflammatory indicators before and after treatment.Adverse reactions that occurred during treatment were evaluated.Results The total response rate in the observation group (97.50%) was significantly higher than that in the control group (80.00%),P<0.05.After treatment,forced vital capacity (FVC) and forced expiratory volume in 1 second in the observation group were (1.99±0.53) L and (2.55±0.45) L,significantly higher than (1.72±0.46) L and (2.11±0.52) L in the control group (P<0.05).After treatment,partial pressure of oxygen (PaO_2) in the observation group was (85.34±12.39) mmHg,significantly higher than (71.43±11.87) mmHg in the control group,and partial pressure of carbon dioxide (PaCO_2) was (60.11±8.35) mmHg,significantly lower than (69.06±9.84) mmHg in the control group,with statistically significant differences (P<0.05).After treatment,the levels of interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α),and EOS in the observation group were (42.37±5.72) ng/L,(23.71±5.21) ng/L,and (4.53±1.13)%,significantly lower than (51.19±6.37) ng/L,(32.63±6.01) ng/L,and (8.46±2.14)%in the control group (P<0.05).The total incidence rates of adverse reactions in the two groups were 10.00%and 5.00%,with no statistically significant difference between the two groups (P>0.05).Conclusion The combined treatment with BiPAP and aerosol inhalation of GC via pipelines can achieve significant therapeutic effects on patients with AECOPD complicated with T2RF,which can significantly improve the patients’pulmonary function,blood gas,and inflammatory state,with high safety.