无创正压通气联合雾化吸入对慢性阻塞性肺疾病加重期患者的疗效分析

目的分析慢性阻塞性肺疾病加重期（AECOPD）患者行无创正压通气联合布地奈德、异丙托溴铵雾化吸入治疗的临床疗效及患者血清中肺部活化调节趋化因子配体18（CCL-18）和生长分化因子15（GDF-15）表达水平变化情况。 方法将在常州市中医医院门诊就诊的80例AECOPD患者采用随机信封法分为观察组及对照组，每组各40例。对照组采用正压通气治疗，观察组采用无创正压通气联合布地奈德、异丙托溴铵雾化吸入治疗。对两组患者的临床疗效、治疗前及治疗结束后72 h的呼吸困难评分、肺功能、动脉血气分析以及血清中的CCL18和GDF-15水平进行评估，记录两组患者不良反应发生情况。 结果观察组患者的临床有效率较对照组显著提高80.00%（32/40）vs. 67.50%（27/40），χ²= 4.036，P= 0.045]。两组患者治疗后的第一秒用力呼气容积（FEV1）（1.69 ± 0.23）L vs.（1.43 ± 0.19）L]、FEV1占用力肺活量（FVC）百分比（71 ± 4）% vs.（65 ± 4）%]、最大呼气流速（PEF）（3.98 ± 0.27）L/s vs.（3.15 ± 0.31）L/s]、呼吸困难评分（1.02 ± 0.27）分vs.（1.65 ± 0.32）分]、肺泡氧分压（PaO₂）（87.4 ± 1.8）mmHg vs.（70.2 ± 2.0）mmHg]、动脉血二氧化碳分压（PaCO₂）（41 ± 5）mmHg vs.（59 ± 3）mmHg]、pH值（7.43 ± 0.03）vs.（7.33 ± 0.02）]、动脉血氧饱和度（SaO₂）（95.7 ± 2.1）% vs.（91.2 ± 2.1）%]、CCL-18（1.13 ± 0.12）μg/L vs.（1.68 ± 0.21）μg/L]及GDF-15（0.61 ± 0.12）μg/L vs.（1.02 ± 0.22）μg/L]水平比较，差异均有统计学意义（t= 3.968、8.011、9.387、6.870、47.220、19.562、13.519、12.385、10.386、10.347，P均< 0.05）；观察组患者治疗前后FEV1、FEV1/FVC、PEF、呼吸困难评分、PaO₂、PCO₂、pH、SaO₂、CCL-18及GDF-15水平比较，差异均有统计学意义（t= 6.311、21.727、12.276、20.406、68.100、27.028、14.952、24.845、21.361、35.294，P均< 0.05）。两组患者不良反应发生率比较，差异无统计学意义12.50%（5/40）vs. 17.50%（7/40），χ²= 0.980，P= 0.322]。 结论采用无创正压通气联合布地奈德、异丙托溴铵雾化吸入治疗AECOPD患者可显著提高临床疗效，并改善血清中CCL-18及GDF-15水平。

Effect of noninvasive positive pressure ventilation combined with nebulization on patients with exacerbation of chronic obstructive pulmonary disease

ObjectiveTo analyze the clinical effect of noninvasive positive pressureventilation combined with budesonide and ipratropium nebulization and the changes of serum CC-chemokine ligand 18 (CCL-18) and growth differentiation factor 15 (GDF-15) in patients with chronic obstructive pulmonary disease (AECOPD). MethodsEighty AECOPD patients in Changzhou Traditional Chinese Medicine Hospital were randomly divided into the observation group (n= 40) and control group (n= 40). The control group was treated with positive pressure ventilation, and the observation group was treated with noninvasive positive pressure ventilation combined with budesonide and ipratropium nebulization. The clinical efficacy, dyspnea score, pulmonary function, arterial blood gas and serum CCL-18 and GDF-15 levels before and 72 hours after treatment in both groups were evaluated. Meanwhile, the occurrence of adverse reactions in patients was recorded. ResultsThe clinical effective rate of the observation group was significantly higher than that of the control group 80.00% (32/40) vs. 67.50% (27/40), χ²= 4.036, P= 0.045]. The expressions of forced expiratory volume in one second (FEV1) (1.69 ± 0.23) L vs. (1.43 ± 0.19) L], ratio of FEV1/forced vital capacity (FEV1/FVC) (71 ± 4)% vs. (65 ± 4)%], peak expiratory flow (PEF) (3.98 ± 0.27) L/s vs. (3.15 ± 0.31) L/s], dyspnea score (1.02 ± 0.27) vs. (1.65 ± 0.32)], alveolar oxygen partial pressure (PaO₂) (87.4 ± 1.8) mmHg vs. (70.2 ± 2.0) mmHg], partial pressure of carbon dioxide in artery (PCO₂) (41 ± 5) mmHg vs. (59 ± 3) mmHg], pH (7.43 ± 0.03) vs. (7.33 ± 0.02)], arterial oxygen saturation (SaO₂) (95.7 ± 2.1)% vs. (91.2 ± 2.1)%], CCL-18 (1.13 ± 0.12) μg/L vs. (1.68 ± 0.21) μg/L] and GDF-15 (0.61 ± 0.12) μg/L vs. (1.02 ± 0.22) μg/L] after treatment of these two groups were statistically significantly different (t= 3.968, 8.011, 9.387, 6.870, 47.220, 19.562, 13.519, 12.385, 10.386, 10.347; all P < 0.05). The FEV1, FEV1/FVC, PEF, dyspnea score, PaO₂, PCO₂, pH, SaO₂, CCL-18 and GDF-15 levels before and after treatment in the observation group were significantly different (t= 6.3111, 21.727, 12.276, 20.406, 68.100, 27.028, 14.952, 24.845, 21.361, 35.294; all P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups 12.50% (5/40) vs. 17.50% (7/40); χ²= 0.980, P= 0.322]. ConclusionNoninvasive positive pressure ventilation combined with budesonide and ipratropium nebulization can significantly improve the clinical efficacy and levels of serum CCL-18 and GDF-15 in AECOPD patients.