BiPAP治疗重度支气管哮喘急性发作期的临床效果及肺功能、血气指标和炎性因子水平变化情况

目的观察重度支气管哮喘急性发作期患者应用口鼻面罩的双水平正压通气(BiPAP)治疗临床效果及肺功能、血气指标和γ-干扰素(IFN-γ)、白细胞介素-17(IL-17)及IL-33变化情况。方法选取2011年9月至2016年5月于无锡市锡山人民医院住院治疗的68例重度支气管哮喘急性发作期患者作为研究对象,按随机数字表法分为研究组和对照组各34例。两组患者均给予常规吸氧、解痉平喘、控制感染、祛痰、纠正水电解质紊乱及保持酸碱平衡等治疗。对照组在常规治疗基础上应用异丙托溴铵溶液,雾化吸入2.0mL,每次8h;甲泼尼龙琥珀酸钠40mg,每次12h。研究组在对照组基础上联合应用BiPAP无创通气治疗,上机通气时间每天大于或等于4h,连续使用大于或等于2d。两组患者疗程均为1周。比较两组患者临床症状改善情况及肺功能、血气指标、炎性因子(IFN-γ、IL-17、IL-33)水平变化。结果研究组在肺功能、血气指标、临床症状改善程度、减轻炎性反应方面均优于对照组,差异均有统计学意义(P0.05)。结论重度支气管哮喘急性发作期患者应用BiPAP通气治疗,能显著改善患者肺功能及血气指标,降低IFN-γ、IL-17及IL-33水平,值得临床推广应用。

Clinical effect of BiPAP in the treatment of severe bronchial asthma in acute attack period and the changes of pulmonary function,blood gas indexes,and inflammatory factors

Objective To observe the clinic effects of BiPAP in the treatment of severe bronchial asthma in acute attack period , and the changes of pulmonary function ,blood gas indexes and interferon gamma (IFN‐γ) ,interleukin‐17(IL‐17) ,IL‐33 .Methods Totally 68 cases of patients with acute exacerbation of severe bronchial asthma were selected ,which were treated in the People′s Hospital of Xishan from September 2011 to May 2016 ,and were divided into the study group (34 cases) and control group (34 ca‐ses) .The patients of two groups were treated with conventional oxygen ,antispasmodic ,infection control ,expectorant ,correct water and electrolyte imbalance ,maintaining acid‐base balance .The patients of control group were treated with ipratropium bromide solu‐tion (inhalation 2 .0 mL ,8 h/time) and methylprednisolone sodium succinate (40 mg ,12 h/time) .On the basis of the control group , the patients of study group were treated with BiPAP non‐invasive ventilation (the machine ventilation ≥4 h /d ,continuous use ≥2 d) .A course of two groups were one week .The changes of clinical symptoms and pulmonary function ,blood gas indexes ,inflam‐matory factors (IFN‐γ,IL‐17 ,IL‐33) were compared between the two groups .Results The study group was better than the control group in terms of lung function ,blood gas index ,clinical symptoms improvement degree ,and reduce the inflammatory reaction ,the difference was statistically significant (P<0 .05) .Conclusion With treating acute exacerbation of severe bronchial asthma ,BiPAP ventilation can significantly improve lung function and blood gas index ,reduce the levels of IFN‐γ,IL‐17 and IL‐33 ,which makes it worthy of clinical application .