布地格福吸入气雾剂联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭患者的临床研究

Clinical trial of budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with non-invasive positive pressure ventilation in the treatment of patients with chronic obstructive pulmonary disease complicated with respiratory failure

目的 观察布地格福吸入气雾剂联合无创正压通气(NPPV)在慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者中的应用效果及对患者血气、肺功能、气道阻力的影响。方法 回顾性队列收集COPD合并呼吸衰竭患者的病历资料,分为对照组和试验组。2组患者在化痰、抗感染、营养支持等常规治疗基础上,均进行NPPV治疗,同时对照组给予异丙托溴铵吸入喷雾剂,每次2掀,每天3次;试验组给予布地格福吸入气雾剂,每次2掀,每天2次。2组患者均连续治疗2周。评价2组患者的临床疗效,比较2组治疗前后动脉血氧饱和度(SaO_(2))、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC值、总气道阻力(R5)、呼吸总阻抗(Z5)、共振频率(Fres)及血清白细胞介素-6(IL-6)、C反应蛋白(CRP)及降钙素原(PCT)。记录患者药物不良反应发生情况。结果 对照组46例和试验组54例。治疗后,试验组和对照组总有效率分别为96.30%(52例/54例)和82.61%(38例/46例),SaO_(2)分别为(88.75±6.08)和(82.25±5.64)mmHg, PaO_(2)分别为(72.26±7.73)和(59.96±4.28)mmHg, PaCO_(2)分别为(51.02±8.18)和(58.48±7.76)mmHg, FEV1分别为(2.07±0.51)和(1.75±0.42)L,FVC分别为(2.48±0.55)和(2.16±0.48)L,FEV1/FVC分别为(71.28±9.42)%和(63.34±8.03)%,R5分别为(102.64±17.14)%和(136.21±15.77)%,Z5分别为(105.41±16.25)%和(138.51±18.44)%,Fres分别为(13.94±2.74)和(17.51±2.48)Hz, IL-6分别为(3.64±0.57)和(4.83±0.62)μg·L^(-1),CRP分别为(8.06±2.15)和(10.34±2.26)mg·L^(-1),PCT分别为(0.57±0.16)和(0.86±0.25)ng·mL^(-1),在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组患者的药物不良反应发生率分别为12.96%(7例/54例)和8.70%(4例/46例),在统计学上差异无统计学意义(P>0.05)。结论 布地格福吸入气雾剂用于COPD合并呼吸衰竭NPPV治疗患者疗效确切,可有效改善患者血气,利于肺功能恢复、气道阻力减小,机制可能与其能更好缓解气道炎症有关。

Objective To observe the application effect of budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with non-invasive positive pressure ventilation(NPPV)in the treatment of patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure undergoing and the influence on blood gas,pulmonary function and airway resistance.Methods Adopting retrospective study,patients with COPD complicated with respiratory failure were divided into control group and treatment group.All patients in both groups were treated with NPPV on the basis of routine treatments such as resolving phlegm,anti-infection and nutritional support,and the control group was treated with ipratropium bromide inhalation spray(2 sprays every time,three times a day),and the treatment group was given Budigefu inhalation aerosol(2 inhalations every time,twice a day).Patients in both groups were continuously treated for 2 weeks.Clinical efficacy was evaluated,and the arterial oxygen saturation(SaO_(2)),partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),forced expiratory volume in 1 second(FEV_(1)),forced vital capacity(FVC),FEV_(1)/FVC,respiratory resistance at 5 Hz(R5),respiratory impedance at 5 Hz(Z5),resonant frequency(Fres),serum interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)were compared before and after treatment in two groups,and adverse drug reactions were recorded in two groups.Results There were 46 cases in control group and 54 cases in treatment group.After treatment,the total effective rates in treatment group and control group were 96.30%(52 cases/54 cases)and 82.61%(38 cases/46 cases),SaO_(2) values were(88.75±6.08)and(82.25±5.64)mmHg,PaO_(2) values were(72.26±7.73)and(59.96±4.28)mmHg,PaCO_(2) values were(51.02±8.18)and(58.48±7.76)mmHg,FEV_(1) values were(2.07±0.51)and(1.75±0.42)L,FVC values were(2.48±0.55)and(2.16±0.48)L,FEV_(1)/FVC values were(71.28±9.42)%and(63.34±8.03)%,R5 values were(102.64±17.14)%and(136.21±15.77)%,Z5values were(105.41±16.25)%and(138.51±18.44)%,Fres values were(13.94±2.14)and(17.51±2.48)Hz,IL-6 levels were(3.64±0.57)and(4.83±0.62)μg·L^(-1),CRP levels were(8.06±2.15)and(10.34±2.26)mg·L^(-1),PCT levels were(0.57±0.16)and(0.86±0.25)ng·mL^(-1),all with significant difference(all P<0.05).The total incidence rates of adverse drug reactions in treatment group and control group were12.96%(7 cases/54 cases)and 8.70%(4 cases/46 cases),with no significant difference(P>0.05).Conclusion Budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol has an exact efficacy in the treatment of COPD patients with respiratory failure undergoing NPPV,and it can effectively improve the blood gas,promote the pulmonary function recovery and reduce the airway resistance,and the mechanism may be related to its better alleviation of airway inflammation.