莫西沙星溶液雾化吸入配合无创呼吸机治疗慢性阻塞性肺疾病急性加重合并肺部感染的效果

Effect of Nebulized Inhalation of Moxifloxacin with Non⁃invasive Ventilator for the Treatment of AECOPD Complicated with Pulmonary Infection

目的 探讨莫西沙星溶液雾化吸入配合无创呼吸机治疗慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)合并肺部感染的效果。方法 选取2020年1月-2023年1月收治的AECOPD合并肺部感染120例,采用随机数字表法分为观察组和对照组各60例。2组均予以常规治疗,于此基础上,对照组予以无创呼吸机治疗,观察组予以莫西沙星溶液雾化吸入配合无创呼吸机治疗。2组均治疗2周。比较2组临床疗效及治疗前、治疗3 d后、治疗7 d后辅助呼吸肌评分、急性生理学和慢性健康状况评价Ⅱ(acute physiological and chronic health statusⅡ, APACHEⅡ)评分、血气分析[动脉血二氧化碳分压(partial pressure of carbon dioxide, PaCO_(2))、动脉血氧分压(arterial oxygen partial pressure, PaO2)、动脉血氧饱和度(arterial oxygen saturation, SaO2)]、血清炎性因子[肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、白细胞介素-6(interleukin-6, IL-6)、C反应蛋白(C response protein, CRP)]、NOD样受体蛋白3(NOD-like receptor protein 3, NLRP3)/半胱氨酸天冬氨酸蛋白酶-1(Caspase-1)/白细胞介素-1β(IL-1β)炎症免疫信号通路相关mRNA表达。结果 观察组总有效率[96.67%(58/60)]较对照组[85.00%(51/60)]高(P<0.05);治疗3 d、7 d后,观察组辅助呼吸肌评分、APACHEⅡ评分及TNF-α、IL-6、CRP水平、NLRP3、Caspase-1、IL-1β mRNA低于对照组(P<0.05);治疗3 d、7 d后,观察组PaO_(2)、SaO_(2)较对照组升高,PaCO_(2)较对照组降低(P<0.05)。观察组不良反应发生率[13.33%(8/60)]与对照组[8.33%(5/60)]比较差异无统计学意义(P>0.05)。结论 莫西沙星溶液雾化吸入配合无创呼吸机能改善AECOPD合并肺部感染患者血气指标,降低血清炎性因子,改善患者健康状况,疗效显著,可能与调节NLRP3/Caspase-1/IL-1β炎症免疫信号通路有关。

Objective To investigate the effect of nebulized inhalation of Moxifloxacin solution combined with non-invasive ventilator in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pulmonary infection.Methods A total of 120 patients with AECOPD complicated with pulmonary infection from January 2020 to January 2023 were selected and divided into observation group(n=60)and control group(n=60)by random num-ber table method.Both groups were given conventional treatment.On this basis,the control group was given non-invasive ventilator,and the observation group was given nebulized inhalation of Moxifloxacin solution combined with non-invasive venti-lator.Both groups were treated for 2 weeks.The clinical efficacy,auxiliary respiratory muscle score,acute physiological and chronic health statusⅡ(APACHEⅡ)score,blood gas analysis[partial pressure of carbon dioxide(PaCO2),arterial oxy-gen partial pressure(PaO2),arterial oxygen saturation(SaO2)],serum inflammatory factor[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C response protein(CRP)],and mRNA expression related to NOD-like receptor protein 3(NLRP3)/Caspase-1/interleukin-1β(IL-1β)inflammatory and immune signaling pathways before treatment,and at 3 d and 7 d after treatment were compared between the two groups.Results The total effective rate of observation group[96.67%(58/60)]was higher than that of control group[85.00%(51/60)](P<005).At 3 and 7 d after treatment,the scores of auxiliary respiratory muscle,APACHEⅡscores,levels of TNF-α,IL-6,CRP,NLRP3,Caspase-1 and IL-1βmRNA in ob-servation group were lower than those in control group(P<005).At 3 and 7 d after treatment,PaO2 and SaO2 in the obser-vation group were higher than those in the control group,while PaCO2 was lower than that in the control group(P<005).Conclusion Nebulized inhalation of Moxifloxacin solution combined with non-invasive ventilator can improve blood gas inde-xes,reduce serum inflammatory factors,and improve the health status of patients with AECOPD complicated with pulmonary infection,and the therapeutic effect is significant,which may be related to the regulation of NLRP3/Caspase-1/IL-1βinflam-matory and immune signaling pathway.