Efficiency of non-invasive mechanical ventilation in treating patients with chronic obstructive pulmonary disease complicated with type Ⅱrespiratory failure
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摘要:目的 探讨无创机械通气对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者炎性因子、血气指标及肺功能的影响。方法 选择95例COPD合并Ⅱ型呼吸衰竭患者，采用随机数字表法分为观察组48例与对照组47例。对照组采用常规对症治疗，观察组联合应用无创机械通气治疗。治疗2周后，比较2组临床疗效、炎性因子指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、血气指标{动脉血氧饱和度(SaO2)、二氧化碳分压[p(CO2)]、氧分压[p(O2)]}、肺功能指标[第1秒用力呼气容积占预计值百分比(FEV1%)、用力肺活量(FVC)、呼气峰流速度(PEF)]等。结果 观察组总有效率91.67%, 显著高于对照组74.47%(P < 0.05)。与治疗前比较, 2组治疗后CRP、IL-6、TNF-α水平均显著降低(P < 0.01), 且观察组显著低于对照组(P < 0.01)。与治疗前比较, 2组治疗后p(O2)、SaO2均显著升高, p(CO2)显著降低(P < 0.05或P < 0.01); 治疗后，观察组p(O2)、SaO2显著高于对照组, p(CO2)显著低于对照组(P < 0.05)。与治疗前比较, 2组治疗后FEV1%、FVC、PEF等指标均显著升高(P < 0.05或P < 0.01), 且观察组FEV1%、FVC、PEF显著高于对照组(P < 0.05或P < 0.01)。结论 无创机械通气有助于抑制慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者炎症反应，改善呼吸功能，提高治疗效果。Abstract:Objective To investigate the effect of non-invasive mechanical ventilation on inflammatory factors, blood gas indexes and lung function in patients with chronic obstructive pulmonary disease (COPD) complicated with type II respiratory failure.Methods Totally 95 COPD patients complicated with type Ⅱrespiratory failure were randomly divided into observation group (n=48) and control group (n=47). The control group was treated with routine symptomatic treatment, while the observation group was treated with non-invasive mechanical ventilation on the basis of control group. After 2 weeks of treatment, the clinical efficacy, inflammatory factors [C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], blood gas indexes{arterial oxygen saturation (SaO2), partial pressure of carbon dioxide [p(CO2)], partial pressure of oxygen [p(O2)]} and pulmonary function of the two groups were compared.Results The total effective rate was 91.67% in the observation group, which was significantly higher than 74.47% in the control group (P < 0.05). Compared with treatment before, the levels of CRP, IL-6 and TNF-α in both groups were significantly lower after treatment (P < 0.01), and those indexes in the observation group were significantly lower than the control group (P < 0.01). Compared with treatment before, p(O2) and SaO2 in both groups increased significantly, and p(CO2) decreased significantly after treatment (P < 0.05 or P < 0.01). After treatment, p(O2) and SaO2 in the observation group were significantly higher than those in the control group, while p(CO2) was significantly lower than those in the control group (P < 0.05). Compared with treatment before, FEV1%, FVC and PEF in both groups increased significantly after treatment (P < 0.05 or P < 0.01), and FEV1%, FVC and PEF in the observation group were significantly higher than those in the control group (P < 0.05 or P < 0.01).Conclusion Non-invasive mechanical ventilation can inhibit inflammation, improve respiratory function and enhance therapeutic effect of COPD patients with type II respiratory failure.
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表 1 2组患者一般资料比较(x±s)
组别 n 男 女 年龄/岁 病程/年 观察组 48 28 20 62.45±7.24 8.12±1.02 对照组 47 31 16 61.20±7.45 7.86±1.12 
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表 2 2组临床疗效比较[n(%)]
组别 n 显效 有效 无效 总有效 观察组 48 30(62.50) 14(29.17) 4(8.33) 44(91.67)* 对照组 47 18(38.30) 17(36.17) 12(25.53) 35(74.47) 与对照组比较, *P < 0.05。
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表 3 2组血清炎性因子水平比较(x±s)
时点 组别 CRP/(mg/L) IL-6/(pg/mL) TNF-α/(pg/mL) 治疗前 观察组(n=48) 44.56±6.12 72.12±9.45 103.45±14.32 对照组(n=47) 43.24±5.75 70.56±9.24 100.54±12.45 治疗后 观察组(n=48) 7.86±1.24**## 15.21±3.12**## 31.12±5.15**## 对照组(n=47) 21.35±4.23** 28.65±4.54** 54.65±7.20** CRP: C反应蛋白; IL-6: 白介素-6; TNF-α: 肿瘤坏死因子-α。与治疗前比较, **P < 0.01; 与对照组比较, ##P < 0.01。
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表 4 2组血气指标比较(x±s)
时点 组别 p(CO2)/mmHg p(O2)/mmHg SaO2/% 治疗前 观察组(n=48) 67.54±9.12 41.36±6.24 75.15±9.20 对照组(n=47) 66.12±8.24 42.74±6.38 76.53±8.35 治疗后 观察组(n=48) 42.45±6.20**## 83.12±6.54**## 94.12±3.45**## 对照组(n=47) 50.24±7.12** 74.56±8.20** 87.45±6.45* SaO2: 动脉血氧饱和度; p(CO2): 二氧化碳分压; p(O2): 氧分压。
与治疗前比较, *P < 0.05, **P < 0.01; 与对照组比较, ##P < 0.01。
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表 5 2组肺功能指标比较(x±s)
时点 组别 FEV1%/% FVC/L PEF/(mL/s) 治疗前 观察组(n=48) 53.45±7.12 2.32±0.42 1.75±0.32 对照组(n=47) 54.32±7.20 2.35±0.36 1.78±0.34 治疗后 观察组(n=48) 72.45±3.12**## 3.12±0.40**## 2.72±0.40**## 对照组(n=47) 65.36±5.20** 2.74±0.35* 2.21±0.42* FEV1%: 第1秒用力呼气容积占预计值百分比; FVC: 用力肺活量; PEF: 呼气峰流速度。
与治疗前比较, *P < 0.05, **P < 0.01; 与对照组比较, ##P < 0.01。
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