噻托溴铵治疗慢性阻塞性肺疾病急性加重期合并急性呼吸衰竭的临床研究

目的 探讨慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）合并急性呼吸衰竭患者应用噻托溴铵治疗的临床疗效。方法 选取2019年3月至2022年3月湖州市第一人民医院收治的106例AECOPD合并急性呼吸衰竭患者,根据随机数字表法将其分为观察组和对照组,每组各53例。两组患者均给予常规治疗,对照组予以无创双相气道正压通气治疗,观察组在对照组的基础上加用噻托溴铵治疗。两组患者均治疗14d。比较两组患者的临床疗效、肺功能、血气指标、炎症因子及不良反应发生情况。结果 观察组患者的治疗总有效率显著高于对照组（94.34% vs. 79.25%,χ2=5.267,P=0.023）。治疗后,观察组患者的第1秒用力呼气容积、第1秒用力呼气容积/用力肺活量、呼气流量峰值、pH、经皮动脉血氧饱和度、动脉血氧分压均显著高于对照组（P<0.05）,动脉血二氧化碳分压、白细胞介素-6、白细胞介素-8、肿瘤坏死因子-α及超敏C反应蛋白均显著低于对照组（P<0.05）。两组患者的用药不良反应及呼吸机不良反应发生率比较差异均无统计学意义（P>0.05）。结论 噻托溴铵治疗AECOPD合并急性呼吸衰竭可显著提升疗效,改善患者的肺功能及动脉血气,但需要注意口干等不良反应的及时处理。

Clinical study of tiotropium bromide in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with acute respiratory failure

Objective To investigate the clinical efficacy of tiotropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with acute respiratory failure. Methods A total of 106 patients with AECOPD complicated with acute respiratory failure admitted to the First People’s Hospital of Huzhou from March 2019 to March 2022 were selected and divided into observation group and control group according to random number table method, with 53 cases in each group. Both groups were given routine treatment. The control group was treated with noninvasive biphasic positive airway pressure ventilation. The observation group was treated with tiotropium bromide on the basis of control group. Both groups were treated for 14 days. The clinical efficacy, lung function, blood gas index, inflammatory factors and adverse reactions were compared between two groups. Results The total effective rate of observation group was significantly higher than that of control group (94.34% vs. 79.25%, χ2=5.267, P=0.023). After treatment, forced expiratory volume in one second (FEV1), FEV1/forced vital capacity, peak expiratory flow, pH, percutaneous arterial oxygen saturation and arterial partial pressure of oxygen in observation group were significantly higher than those in control group (P<0.05), while arterial partial pressure of carbon dioxide, interleukin-6, interleukin-8, tumor necrosis factor-α and hypersensitive C-reaction protein were lower than those in control group (P<0.05). There were no significant differences in the incidence of adverse drug reactions and ventilator adverse reactions between two groups (P>0.05). Conclusion Titropium bromide in the treatment of AECOPD complicated with acute respiratory failure can significantly improve the curative effect, improve pulmonary function and arterial blood gas, but attention should be paid to the timely treatment of adverse reactions of dry mouth.