血清胆碱酯酶在慢性阻塞性肺疾病伴呼吸衰竭行无创呼吸机辅助呼吸患者中的变化及意义

目的：探讨血清胆碱酯酶(ChE)在慢性阻塞性肺疾病(COPD)伴呼吸衰竭需经无创呼吸机辅助呼吸治疗患者中的变化特点，并分析其临床意义。方法选取我院呼吸内科2014年2月至2015年1月收治的104例COPD伴呼吸衰竭患者，按是否需要行无创呼吸机辅助呼吸治疗分为观察组45例和对照组59例。对照组行常规药物治疗，观察组在对照组的基础上采用无创呼吸机辅助治疗。比较两组患者的治疗效果及入、出院时全血胆碱酯酶活力（blChE）、红细胞胆碱酯酶活力（eChE）、血浆胆碱酯酶活力(pChE)的变化。结果观察组患者治疗的总有效率为100.00%，与对照组的98.31%比较差异无统计学意义(P>0.05)；观察组患者入院时的blChE、eChE、pChE分别为(3.82±1.26)×1012/L、(3.08±0.76)×1012/L、（0.56±0.21）×1012/L，明显低于对照组的(5.08±1.35)×1012/L、(3.72±0.83）×1012/L、(0.83±0.26)×1012/L，差异均有统计学意义(P<0.05)；观察组出院时的blChE、eChE、pChE分别为（4.96±1.33）×1012/L、(3.69±0.84)×1012/L、（0.71±0.25）×1012/L，与对照组的(5.12±1.27)×1012/L、(3.81±0.72)×1012/L、（0.75±0.29）×1012/L比较差异均无统计学意义(P>0.05)；与治疗前相比较，观察组治疗后blChE、eChE、pChE水平均明显更高(P<0.05)，而对照组则差异无统计学意义(P>0.05)。结论 COPD伴呼吸衰竭患者ChE水平有明显降低，经无创呼吸机治疗后呈现明显的升高趋势，故ChE可作为判断无创呼吸机辅助呼吸治疗COPD伴呼吸衰竭患者临床疗效的评价指标。

Changes and clinical significance of ChE in patients of COPD complicated with respiratory failure treated with noninvasive ventilator-assisted ventilation

Objective To discuss the changes and clinical significance of Cholinesterase (ChE) in patients of chronic obstructive pulmonary disease (COPD) complicated with respiratory failure treated with noninvasive ventila-tor-assisted ventilation. Methods A total of 104 cases of patients with COPD complicated with respiratory failure, who admitted to Department of Respiratory Medicine of our hospital from February 2014 to January 2015, were selected and divided into the observation group (n=45, conventional drug treatment) and the control group (n=59, conventional drug treatment and noninvasive ventilator-assisted ventilation) according to whether undergoing noninvasive mechanical ventila-tion treatment. The curative effect and the preoperative and postoperative changes of butyrylcholinesterase (blChE), eryth-rocyte cholinesterase (eChE) and serum pseudocholinesterase (pChE) in the two groups were compared. Results The to-tal effective rate in the observation group was 100.00%, which had no significant differences with 98.31%in the con-trol group (P>0.05). The preoperative levels of blChE, eChE and pChE in the observation group [(3.82 ± 1.26) × 1012/L, (3.08 ± 0.76) × 1012/L, (0.56 ± 0.21) × 1012/L, respectively] were significantly lower than those in the control group [(5.08±1.35)×1012/L, (3.72±0.83)×1012/L, (0.83±0.26)×1012/L, respectively], P<0.05. There was no significant difference between the observation group [(4.96±1.33)×1012/L, (3.69±0.84)×1012/L, (0.71±0.25)×1012/L, respectively] and the con-trol group [(5.12 ± 1.27) × 1012/L, (3.81 ± 0.72) × 1012/L, (0.75 ± 0.29) × 1012/L, respectively] in the postoperative levels of blChE, eChE and pChE (P>0.05). Compared with before treatment, the postoperative levels of blChE, eChE and pChE significantly increased (P<0.05), but there was no significant difference in the control group (P>0.05). Conclusion The ChE levels of patients with COPD complicated with respiratory failure have decreased significantly, which increase with the treatment of non-invasive ventilation. So ChE could be used as the clinical efficacy evaluation index of noninvasive ventilator-assisted ventilation in the treatment of patients with COPD complicated with respiratory failure.