强化血糖控制对AECOPD无创通气的影响

目的探讨强化血糖控制AECOPD伴应激性高血糖在无创通气治疗中的作用。方法 160例AECOPD导致2型呼吸衰竭伴应激性高血糖患者,随机分为强化血糖控制组(强化组)和常规治疗组(常规组),观察两组患者无创通气时间和失败率、28天死亡率;并用酶联免疫吸附试验法(ELISA)测定治疗前、治疗后第3天和7天血清中白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)浓度。结果强化组无创通气时间及无创通气的失败率与常规组相比均显著减少(P<0.05);强化组患者第3天和第7天血清中IL-6和TNF-α的浓度明显低于常规组;两组死亡率无显著统计学差异。结论强化血糖控制提高AECOPD伴应激性高血糖患者的无创通气疗效。

Effect of insulin intensive therapy on acute exacerbation of chronic obstructive pulmonary disease with Noninvasive mechanical ventilation

Objective To explore the effect of insulin intensive therapy in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with noninvasive positive-pressure mechanical ventilation(NPPV).Methods A total of 160 type Ⅱ respiratory failure patients with AECOPD complicated with stress hyperglycemia needing NPPV were randomly divided into intensive insulin therapy group and control group.The time and failure rate of NPPV and mortality were observed.ELISA was used to determine the levels of tumor necrosis factor-α,and interlukin-6.Results The time and failure rate of NPPV in intensive insulin therapy group were significantly lower than that in the control group.After treatment for 3 days,the levels of TNF-α and IL-6 were significantly decreased compared with those in control group.However,the mortality was not significantly different between two groups.Conclusion These results suggested that insulin intensive therapy is valuable in AECOPD with NPPV while complicated with stress hyperglycemia.