无创正压通气+常规治疗在COPD并Ⅱ型呼吸衰竭患者中的应用价值

杨东霞 苏炜欣 黄晓霞

【摘要】 目的：探討无创正压通气以及常规治疗对慢性阻塞性肺疾病（COPD）并Ⅱ型呼吸衰竭患者炎症状态、心功能以及血气参数的影响。方法：选取2016年9月-2017年9月本院收治的60例COPD并Ⅱ型呼吸衰竭患者，按照随机数字表法将其分为观察组和对照组，各30例。对照组采取一般常规治疗，观察组在对照组基础上，进行无创正压通气的辅助治疗。连续治疗2周后，比较两组炎症状态（hs-CRP、IL-33、PGE2、sICAM-1、PCT）、心功能（NTpro-BNP、GDF-15、CysC、Copeptin、APN）以及血气参数（Cl-、PaCO2、CO2CP、pH、PaO2）。结果：治疗后，观察组血清hs-CRP、IL-33、PGE2、sICAM-1、PCT等相关炎症因子水平均低于对照组，差异均有统计学意义（P<0.05）;治疗后，观察组血清NTpro-BNP、GDF-15、CysC、Copeptin、APN水平均低于对照组，差异均有统计学意义（P<0.05）;治疗后，观察组CI-、PaCO2、CO2CP均低于对照组，pH、PaO2均高于对照组，差异均有统计学意义（P<0.05）。结论：采用无创正压通气联合常规治疗对于改善COPD并Ⅱ型呼吸衰竭患者的炎症状态、心功能以及血气参数有积极的意义，对于改善整体的治疗有正面意义。

【关键词】 慢性阻塞性肺疾病; 无创正压通气; Ⅱ型呼吸衰竭; 血气参数

【Abstract】 Objective：To analyze the effects of noninvasive positive pressure ventilation and conventional therapy on inflammatory state，cardiac function and blood gas parameters in patients with chronic obstructive pulmonary disease（COPD）and type Ⅱ respiratory failure.Method：A total of 60 COPD patients with type Ⅱ respiratory failure admitted to our hospital from September 2016 to September 2017were selected.According to the random number table method，they were divided into observation group and control group，30 cases in each group.The control group received conventional therapy，while observation group received noninvasive positive pressure ventilation on the basis of control group.After two weeks of continuous treatment，the inflammatory status（hs-CRP，IL-33，PGE2，sICAM-1，PCT），cardiac function（NTpro-BNP，GDF-15，CysC，Copeptin，APN）and blood gas parameters（Cl-，PaCO2，CO2，CO2CP，pH，PaO2）between two groups were compared.

Result：After treatment，the serum levels of hs-CRP，IL-33，PGE2，sICAM-1 and PCT in observation group were lower than those of control group，the differences were statistically significant（P<0.05）.After treatment，the serum levels of NTpro-BNP，GDF-15，CysC，Copeptin and APN in observation group were lower than those of control group，the differences were statistically significant（P<0.05）.After treatment，the levels of Cl-，PaCO2 and CO2CP in observation group were lower than those of control group，while pH and PaO2 were higher than those of control group，the differences were statistically significant（P<0.05）.Conclusion：Noninvasive positive pressure ventilation combined with conventional therapy has positive significance for improving inflammation，cardiac function and blood gas parameters of COPD patients with type Ⅱ respiratory failure，and for improving the overall treatment.

【Key words】 Chronic obstructive pulmonary disease; Noninvasive positive pressure ventilation; Type Ⅱ respiratory failure; Blood gas parameter

First-authors address：Shenzhen Second Peoples Hospital，Shenzhen 518000，China

doi：10.3969/j.issn.1674-4985.2019.16.018

慢性阻塞性肺疾病（Chronic obstructive pulmonary disease，COPD）是一种常见的、可以预防和治疗的疾病，其特征是持续存在的呼吸系统症状和气流受限，原因是气道和肺泡异常、通常与显著暴露于毒性颗粒和气体相关。目前大多数COPD是由吸烟引起[1-2]，患者在急性发作期可出现Ⅱ型呼吸衰竭，在临床上这种类型的呼吸衰竭的主要特征为低氧血症和高碳酸血症。此类疾病的常规治疗方法有抗感染、抗炎、舒张支气管、持续的低流量吸氧以及祛痰等。一般来说，患者需要选择机械通气的方式来改善患者自身呼吸衰竭的症状，在临床上，机械通气分为无创机械通气和有创机械通气[3]。同时，无创机械通气作为通气效果更佳的通气方式已经在临床上广泛的应用于COPD的治疗中[4]。本研究将无创正压通气联合常规治疗应用于本院2016年9月-2017年9月收治的60例COPD并Ⅱ型呼吸衰竭患者中，重点讨论了该治疗方案在患者炎症状态、心功能以及血气参数等三个方面的影响，以期为临床治疗提供参考依据。……