无创呼吸机与高流量氧疗对AECOPD合并呼吸衰竭患者呼吸功能及血清IL-6、IL-8、TNF-α水平的影响比较

Effect comparison of non-invasive ventilator and high-flow oxygen therapy on respiratory function and serum IL-6,IL-8 and TNF-αlevels in patients with AECOPD complicated with respiratory failure

目的分析比较无创呼吸机与高流量氧疗对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者呼吸功能及血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平的影响。方法选择60例AECOPD合并呼吸衰竭患者,以随机数表方式分为对照组与研究组,各30例。两组均给予对症支持性治疗,对照组患者予以无创呼吸机治疗,研究组患者则给予高流量氧疗治疗。比较两组患者治疗效果、并发症发生情况及治疗前后的肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)]、血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))与血氧饱和度(SpO_(2))]、血清炎性因子(IL-6、IL-8、TNF-α)水平。结果与对照组(76.67%)相比,研究组治疗总有效率(96.67%)更高(P<0.05)。治疗后,两组FVC、FEV1、FEV1/FVC水平均高于治疗前,且研究组FVC(2.92±0.46)L、FEV1(2.79±0.43)L、FEV1/FVC(81.48±7.67)%分别高于对照组的(2.15±0.35)L、(2.04±0.34)L、(74.72±6.59)%(P<0.05)。治疗后,两组PaO_(2)、PaCO_(2)、SpO_(2)水平较治疗前改善,且研究组PaO_(2)(75.89±7.73)mm Hg(1 mm Hg=0.133 kPa)、SpO_(2)(92.94±5.79)%均较对照组的(68.37±6.69)mm Hg、(87.78±6.53)%高,PaCO_(2)(43.48±4.28)mm Hg较对照组的(49.73±4.84)mm Hg低(P<0.05)。治疗后,两组IL-6、IL-8、TNF-α水平均低于治疗前,且研究组血清IL-6、IL-8、TNF-α水平分别为(12.27±1.17)、(27.27±2.58)、(17.08±1.66)pg/ml,均低于对照组的(17.83±1.68)、(34.72±3.39)、(23.17±2.28)pg/ml(P<0.05)。在并发症发生率上,研究组、对照组分别为6.67%、30.00%,研究组更低(P<0.05)。结论对AECOPD合并呼吸衰竭患者采用高流量氧疗进行治疗的效果确切,能改善患者呼吸功能,并降低血清炎性因子水平,同时患者的并发症发生率更低,值得推广。

Objective To analyze and compare the effects of non-invasive ventilator and high-flow oxygen therapy on respiratory function and serum interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)levels in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure.Methods 60 patients with AECOPD complicated with respiratory failure were selected and divided into a control group and a study group according to random numerical table,with 30 patients in each group.Both groups received symptomatic and supportive treatment,on this basis,the control group was treated with non-invasive ventilator,while the study group was treated with high-flow oxygen therapy.Both groups were compared in terms of therapeutic effects,complications,lung function[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC],blood gas index[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and blood oxygen saturation(SpO_(2))],serum inflammatory factors(IL-6,IL-8 and TNF-α)before and after treatment.Results Compared with the control group(76.67%),the total effective rate of the study group(96.67%)was higher(P<0.05).After treatment,the levels of FVC,FEV1 and FEV1/FVC in both groups were higher than those before treatment;the study group had FVC of(2.92±0.46)L,FEV1 of(2.79±0.43)L and FEV1/FVC of(81.48±7.67)%,which were higher than(2.15±0.35)L,(2.04±0.34)L and(74.72±6.59)%in the control group(P<0.05).After treatment,the levels of PaO_(2),PaCO_(2)and SpO_(2)in both groups were improved compared with those before treatment;the study group had PaO_(2)of(75.89±7.73)mm Hg(1 mm Hg=0.133 kPa)and SpO_(2)of(92.94±5.79)%,which were higher than(68.37±6.69)mm Hg and(87.78±6.53)%in the control group;PaCO_(2)of(43.48±4.28)mm Hg in the study group was lower than(49.73±4.84)mm Hg in the control group(P<0.05).After treatment,the levels of IL-6,IL-8 and TNF-αin both groups were lower than those before treatment;the serum levels of IL-6,IL-8 and TNF-αin the study group were(12.27±1.17),(27.27±2.58)and(17.08±1.66)pg/ml,which were lower than(17.83±1.68),(34.72±3.39)and(23.17±2.28)pg/ml in the control group(P<0.05).The incidence of complications was 6.67%in the study group and 30.00%in the control group,which was lower in the study group(P<0.05).Conclusion High-flow oxygen therapy is effective in the treatment of patients with AECOPD complicated with respiratory failure,which can improve the respiratory function of patients and reduce the level of serum inflammatory factors,and at the same time,the complications of patients are lower,which is worth popularizing.