Objective:T o analyze the effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with chronic obstructive pulmonary disease (COPD) and...Objective:T o analyze the effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with chronic obstructive pulmonary disease (COPD) and type II respiratory failure. Methods:90 patients with COPD and type II respiratory failure were randomly divided into observation group and control group (n=45). Control group received conventional therapy, observation group received conventional therapy+adjuvant noninvasive positive pressure ventilation, and differences in blood gas parameters, cardiac function, inflammatory state, etc., were compared between two groups of patients 2 weeks after treatment. Results:Arterial blood gas parameters pH and alveolar-arterial partial pressure of oxygen [P(A-a)O2] levels of observation group were higher than those of control group while, potassium ion (K+), chloride ion (Cl-) and carbon dioxide combining power (CO2CP) levels were lower than those of control group 2 weeks after treatment;echocardiography parameters Doppler-derived tricuspid lateral annular systolic velocity (DTIS) and pulmonary arterial velocity (PAV) levels were lower than those of control group (P<0.05) while pulmonary artery accelerating time (PAACT), left ventricular end-diastolic dimension (LVDd) and right atrioventricular tricuspid annular plane systolic excursion (TAPSE) levels were higher than those of control group (P<0.05);serum cardiac function indexes adiponectin (APN), Copeptin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), cystatin C (CysC), growth differentiation factor-15 (GDF-15) and heart type fatty acid binding protein (H-FABP) content were lower than those of control group (P<0.05);serum inflammatory factors hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), IL-8, IL-10, and transforming growth factor-β1 (TGF-β1) content were lower than those of control group (P<0.05). Conclusions:Adjuvant noninvasive positive pressure ventilation can optimize the blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure, and it is of positive significance in improving the overall treatment outcome.展开更多
Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV...Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV)was proved to be successful only for AECOPD patients with severe respiratory failure·We hypothesized that, theoutcomes of AECOPD would be improved if NPPVis early (within 24 to 48 hours of admission) administered inthose patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients withoutfulfilling the conventional criteria of mechanical ventilatory support·Methods Aprospective multicentre randomized controlled trial was conducted in19 hospitals in China over16months·Three hundred and forty-two AECOPD patients with pH≥7·25 and PaCO2>45 mmHg were recruitedon general ward and randomly assigned to standard medical treatment (control group) or early administration ofadditional NPPV (NPPV group)·Results The characteristics of two groups on admission were similar·The number of AECOPD patientsrequiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71,P=0·002)·Subgroup analysis showed the needs for intubation in mildly (pH≥7·35) and severe (pH<7·30)acidotic patients in NPPVgroup were both decreased (9/80 vs2/71,P=0·047 and 8/30 vs3/43,P=0·048,respectively)·The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171vs 12/171,P=0·345)·Respiratory rate (RR),scale for accessory muscle use and arterial pHimproved rapidlyat the first 2 hours only in patients of NPPV group·After 24 hours, the differences of pH, PaO2, scale foraccessory muscle use and RR in NPPV group [(7·36±0·06) mmHg, (72±22) mmHg, (2·5±0·9) /min,(22±4) /min] were statistically significant compared with control group (7·37±0·05) mmHg, (85±34)mmHg, (2·3±1·1) /min, (21±4) /min,P<0·01 for all comparisons]·Conclusions The early use of NPPV on general ward improves arterial blood gas and respiratory pattern,decreases the rate of need for intubation in AECOPD patients·NPPV is indicative for alleviating respiratorymuscle fatigue and preventing respiratory failure from exacerbation·展开更多
目的:探讨支气管镜下肺泡灌洗联合无创正压通气(Noninvasive positive-pressure ventilation,NPPV)治疗急性加重期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)伴发Ⅱ型呼吸衰竭患者的疗效。方法:选择2020年2月至2021...目的:探讨支气管镜下肺泡灌洗联合无创正压通气(Noninvasive positive-pressure ventilation,NPPV)治疗急性加重期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)伴发Ⅱ型呼吸衰竭患者的疗效。方法:选择2020年2月至2021年10月在我院接受诊治的急性加重期COPD伴发Ⅱ型呼吸衰竭患者124例,分为肺泡灌洗联合NPPV组和NPPV组(n=62)。NPPV组在常规药物治疗的基础上给予NPPV治疗,肺泡灌洗联合NPPV组在NPPV组治疗基础上给予支气管镜下肺泡灌治疗。治疗期间,记录患者的体温、生命体征恢复时间、症状消失时间及不良反应发生情况;治疗前和治疗2 w后,采用肺功能检测系统测定患者第1秒用力呼气容积(Forced expiratory volume in one second,FEV1)、第1秒用力呼气容积占预计值的百分比(The forced expiratory volume in one second as a percentage of the predicted value,FEV1%prep)、第1秒用力呼气容积与用力肺活量的比值(Forced expiratory volume in one second/forced vital capacity,FEV1/FVC),采用酶联免疫吸附法检测血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、降钙素原(Procalcitonin,PCT)水平,采用免疫比浊法进行检测前白蛋白(Prealbumin,,PAB)水平,采用DxFLEX流式细胞仪检测患者血清CD4^(^(+))、CD8^(+)细胞水平并计算CD4^(+)/CD8^(+)值。结果:治疗后,肺泡灌洗联合NPPV组体温恢复时间、生命体征恢复时间、症状消失时间均少于NPPV组(P<0.05),FEV1、FEV1%prep、FEV1/FVC、PAB水平、CD4^(+)水平、CD4^(+)/CD8^(+)水平均高于NPPV组(P<0.05),TNF-α水平、PCT水平、CD8^(+)水平均低于NPPV组(P<0.05);肺泡灌洗联合NPPV组不良反应发生率与NPPV组比较,差异无统计学意义(P>0.05)。结论:在NPPV基础上联用支气管镜下肺泡灌洗治疗急性加重期COPD伴发Ⅱ型呼吸衰竭患者进行治疗,可改善患者肺功能和临床症状具有积极作用,可有效改善患者免疫功能,缓解机体炎症反应,效果安全可靠。展开更多
文摘Objective:T o analyze the effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with chronic obstructive pulmonary disease (COPD) and type II respiratory failure. Methods:90 patients with COPD and type II respiratory failure were randomly divided into observation group and control group (n=45). Control group received conventional therapy, observation group received conventional therapy+adjuvant noninvasive positive pressure ventilation, and differences in blood gas parameters, cardiac function, inflammatory state, etc., were compared between two groups of patients 2 weeks after treatment. Results:Arterial blood gas parameters pH and alveolar-arterial partial pressure of oxygen [P(A-a)O2] levels of observation group were higher than those of control group while, potassium ion (K+), chloride ion (Cl-) and carbon dioxide combining power (CO2CP) levels were lower than those of control group 2 weeks after treatment;echocardiography parameters Doppler-derived tricuspid lateral annular systolic velocity (DTIS) and pulmonary arterial velocity (PAV) levels were lower than those of control group (P<0.05) while pulmonary artery accelerating time (PAACT), left ventricular end-diastolic dimension (LVDd) and right atrioventricular tricuspid annular plane systolic excursion (TAPSE) levels were higher than those of control group (P<0.05);serum cardiac function indexes adiponectin (APN), Copeptin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), cystatin C (CysC), growth differentiation factor-15 (GDF-15) and heart type fatty acid binding protein (H-FABP) content were lower than those of control group (P<0.05);serum inflammatory factors hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), IL-8, IL-10, and transforming growth factor-β1 (TGF-β1) content were lower than those of control group (P<0.05). Conclusions:Adjuvant noninvasive positive pressure ventilation can optimize the blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure, and it is of positive significance in improving the overall treatment outcome.
基金This study was supported by a grant from Beijing Science andTechnology Committee (No.9555102600)
文摘Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV)was proved to be successful only for AECOPD patients with severe respiratory failure·We hypothesized that, theoutcomes of AECOPD would be improved if NPPVis early (within 24 to 48 hours of admission) administered inthose patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients withoutfulfilling the conventional criteria of mechanical ventilatory support·Methods Aprospective multicentre randomized controlled trial was conducted in19 hospitals in China over16months·Three hundred and forty-two AECOPD patients with pH≥7·25 and PaCO2>45 mmHg were recruitedon general ward and randomly assigned to standard medical treatment (control group) or early administration ofadditional NPPV (NPPV group)·Results The characteristics of two groups on admission were similar·The number of AECOPD patientsrequiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71,P=0·002)·Subgroup analysis showed the needs for intubation in mildly (pH≥7·35) and severe (pH<7·30)acidotic patients in NPPVgroup were both decreased (9/80 vs2/71,P=0·047 and 8/30 vs3/43,P=0·048,respectively)·The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171vs 12/171,P=0·345)·Respiratory rate (RR),scale for accessory muscle use and arterial pHimproved rapidlyat the first 2 hours only in patients of NPPV group·After 24 hours, the differences of pH, PaO2, scale foraccessory muscle use and RR in NPPV group [(7·36±0·06) mmHg, (72±22) mmHg, (2·5±0·9) /min,(22±4) /min] were statistically significant compared with control group (7·37±0·05) mmHg, (85±34)mmHg, (2·3±1·1) /min, (21±4) /min,P<0·01 for all comparisons]·Conclusions The early use of NPPV on general ward improves arterial blood gas and respiratory pattern,decreases the rate of need for intubation in AECOPD patients·NPPV is indicative for alleviating respiratorymuscle fatigue and preventing respiratory failure from exacerbation·
文摘目的:探讨支气管镜下肺泡灌洗联合无创正压通气(Noninvasive positive-pressure ventilation,NPPV)治疗急性加重期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)伴发Ⅱ型呼吸衰竭患者的疗效。方法:选择2020年2月至2021年10月在我院接受诊治的急性加重期COPD伴发Ⅱ型呼吸衰竭患者124例,分为肺泡灌洗联合NPPV组和NPPV组(n=62)。NPPV组在常规药物治疗的基础上给予NPPV治疗,肺泡灌洗联合NPPV组在NPPV组治疗基础上给予支气管镜下肺泡灌治疗。治疗期间,记录患者的体温、生命体征恢复时间、症状消失时间及不良反应发生情况;治疗前和治疗2 w后,采用肺功能检测系统测定患者第1秒用力呼气容积(Forced expiratory volume in one second,FEV1)、第1秒用力呼气容积占预计值的百分比(The forced expiratory volume in one second as a percentage of the predicted value,FEV1%prep)、第1秒用力呼气容积与用力肺活量的比值(Forced expiratory volume in one second/forced vital capacity,FEV1/FVC),采用酶联免疫吸附法检测血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、降钙素原(Procalcitonin,PCT)水平,采用免疫比浊法进行检测前白蛋白(Prealbumin,,PAB)水平,采用DxFLEX流式细胞仪检测患者血清CD4^(^(+))、CD8^(+)细胞水平并计算CD4^(+)/CD8^(+)值。结果:治疗后,肺泡灌洗联合NPPV组体温恢复时间、生命体征恢复时间、症状消失时间均少于NPPV组(P<0.05),FEV1、FEV1%prep、FEV1/FVC、PAB水平、CD4^(+)水平、CD4^(+)/CD8^(+)水平均高于NPPV组(P<0.05),TNF-α水平、PCT水平、CD8^(+)水平均低于NPPV组(P<0.05);肺泡灌洗联合NPPV组不良反应发生率与NPPV组比较,差异无统计学意义(P>0.05)。结论:在NPPV基础上联用支气管镜下肺泡灌洗治疗急性加重期COPD伴发Ⅱ型呼吸衰竭患者进行治疗,可改善患者肺功能和临床症状具有积极作用,可有效改善患者免疫功能,缓解机体炎症反应,效果安全可靠。
