双水平气道正压通气联合氧雾化治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床疗效

The clinical efficacy of non-invasive bilevel positive airway pressure ventilator combined with oxygen atomization in the treatment of chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure

目的探讨双水平气道正压通气(BiPAP)联合氧雾化治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效及安全性。方法采用回顾性研究的方法,选择2019年6月至2021年7月海盐县人民医院收治的80例COPD合并Ⅱ型呼吸衰竭患者作为研究对象,采用随机数字表法分为观察组和对照组,每组40例。两组患者均给予常规治疗,对照组患者连接BiPAP无创呼吸机,采用S/T模式进行无创机械通气;观察组在通气过程中给予雾化吸入药物,两组均连续治疗7 d。于治疗前及治疗后7 d检测血气指标、生命体征指标,采用COPD患者自我评估量表(CAT)及DECAF量表评估临床症状改善情况,测定血清白细胞介素(IL)-10、肿瘤坏死因子-α(TNF-α)、CD 4+/CD 8+水平,统计治疗转归及不良反应发生情况。结果观察组治疗后动脉血氧分压、血氧饱和度高于对照组[(73.41±5.26)mmHg(1 mmHg=0.133 kPa)比(65.11±4.33)mmHg、0.921±0.052比0.884±0.039],动脉血二氧化碳分压低于对照组[(45.20±5.33)mmHg比(50.52±5.96)mmHg],差异有统计学意义(P<0.05)。观察组治疗后心率、呼吸频率低于对照组[(90.12±8.56)次/min比(98.52±9.63)次/min、(17.41±2.26)次/min比(22.10±3.05)次/min],差异有统计学意义(P<0.05)。观察组治疗后CAT、DECAF评分低于对照组[(8.45±1.63)分比(12.77±2.36)分、(0.89±0.15)分比(1.15±0.19)分],差异有统计学意义(P<0.05)。观察组治疗后IL-10、CD 4+/CD 8+水平高于对照组[(15.28±3.12)ng/L比(13.41±2.96)ng/L、1.71±0.38比1.54±0.30],TNF-α水平低于对照组[(215.27±33.96)μg/L比(251.11±50.95)μg/L],差异有统计学意义(P<0.05)。观察组住院时间短于对照组[(13.52±3.96)d比(15.22±2.74)d],差异有统计学意义(P<0.05)。两组气管插管率和不良反应发生率比较差异无统计学意义(P>0.05)。结论BiPAP联合氧雾化治疗可改善COPD合并Ⅱ型呼吸衰竭患者血气指标、生命体征及临床症状,降低炎性反应。

Objective To investigate the clinical efficacy and safety of non-invasive bilevel positive airway pressure(BiPAP)ventilator combined with oxygen atomization in the treatment of chronic obstructive pulmonary disease(COPD)complicated with typeⅡrespiratory failure.Methods A total of 80 patients with COPD complicated with typeⅡrespiratory failure admitted to Haiyan County People′s Hospital from June 2019 to July 2021 were selected,and they were divided into the observation group and the control group by the random number table method,with 40 cases in each group.Patients in both groups received conventional treatment,while patients in the control group were connected with BiPAP non-invasive ventilator and received non-invasive mechanical ventilation in S/T mode;the observation group was given aerosol inhalation drugs during ventilation,and both groups were treated for 7 d.Blood gas indicators and vital signs were collected before treatment and 7 d after treatment.Clinical symptoms were investigated by COPD patient Caring Assessment Tool(CAT)and Dyspnea Scale(DECAF).Serum levels of interleukin(IL)-10,tumor necrosis factor(TNF-α)and CD 4+/CD 8+were determined,and treatment outcomes and adverse reactions were compared between the two groups.Results After treatment,the partial pressure of oxygen(PaO 2)and the oxygen saturation(SaO 2)in the observation group were higher than those in the control group:(73.41±5.26)mmHg(1 mmHg=0.133 kPa)vs.(65.11±4.33)mmHg,0.921±0.052 vs.0.884±0.039;the arterial partial pressure of carbon dioxide(PaCO 2),heart rate(HR),respiratory rate(RR)were lower than those in the control group:(45.20±5.33)mmHg vs.(50.52±5.96)mmHg,(90.12±8.56)times/min vs.(98.52±9.63)times/min,(17.41±2.26)times/min vs.(22.10±3.05)times/min,there were statistical differences(P<0.05).After treatment,CAT scores and DECAF scores in the observation group were lower than those in the control group:(8.45±1.63)scores vs.(12.77±2.36)scores,(0.89±0.15)scores vs.(1.15±0.19)scores,there were statistical differences(P<0.05).After treatment,the levels of IL-10 and CD 4+/CD 8+in the observation group were higher than those in the control group:(15.28±3.12)ng/L vs.(13.41±2.96)ng/L,1.71±0.38 vs.1.54±0.30;while the level of TNF-αwas lower than that in the control group:(215.27±33.96)ng/L vs.(251.11±50.95)ng/L,there were statistical differences(P<0.05).The hospitalization time in the observation group was shorter than that in the control group:(13.52±3.96)d vs.(15.22±2.74)d,there was statistical difference(P<0.05).The rates of tracheal intubation and the incidence of adverse reactions between the two groups had no significant differences(P>0.05).Conclusions Non-invasive BiPAP ventilator combined with oxygen atomization can improve blood gas index,vital signs and clinical symptoms of COPD patients complicated with typeⅡrespiratory failure and reduce inflammatory response.