慢性阻塞性肺疾病合并呼吸衰竭患者应用无创正压通气治疗的价值及对患者血清炎症因子的影响

宗立国　俞亮　韩媛媛

【摘要】 目的：探讨慢性阻塞性肺疾病合并呼吸衰竭患者应用无创正压通气治疗的价值及对患者血清炎症因子的影响。方法：选取2014年6月-2019年6月本院收治的90例慢性阻塞性肺疾病合并呼吸衰竭患者，根据随机数字表法将其分为对照组和研究组，每组45例。对照组采用常规治疗，研究组在对照组的基础上加用无创正压通气治疗。比较两组治疗2周后的疗效及治疗前和治疗2周后的血清炎症因子（hs-CRP、PCT、IL-33、IL-17、sICAM-1）、血气分析（PaO2、PaCO2）、肺功能（FEV1、FVC、FEV1/FVC%）、生命体征（心率、呼吸频率、血氧饱和度）水平。结果：研究组总有效率高于对照组，差异有统计学意义（P<0.05）。治疗前，两组血清hs-CRP、PCT、IL-33、IL-17、sICAM-1水平比较，差异均无统计学意义（P>0.05）;治疗2周后，两组hs-CRP、PCT、IL-33、IL-17、sICAM-1水平均低于治疗前，且研究组均低于对照组，差异均有统计学意义（P<0.05）。治疗前，两组PaO2、PaCO2、FEV1、FVC、FEV1/FVC%水平比较，差异均无统计学意义（P>0.05）;治疗2周后，两组PaO2、PaCO2、FEV1、FVC、FEV1/FVC%水平均优于治疗前，且研究组均优于对照组，差异均有统计学意义（P<0.05）。治疗前，两组患者心率、呼吸频率、血氧饱和度水平比较，差异均无统计学意义（P>0.05）;治疗2周后，两组心率、呼吸频率、血氧饱和度水平均优于治疗前，且研究组均优于对照组，差异均有统计学意义（P<0.05）。结论：慢性阻塞性肺疾病合并呼吸衰竭患者應用无创正压通气治疗的价值较高、效果较好，可有效改善患者的血气分析、肺功能以及生命体征，减轻炎症反应，对于促进康复具有重要的意义。

【关键词】 无创正压通气 慢性阻塞性肺疾病 呼吸衰竭 血清炎症因子

[Abstract] Objective： To investigate the value of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease （COPD） complicated with respiratory failure and its influence on serum inflammatory factors. Method： A total of 90 patients with chronic obstructive pulmonary disease complicated with respiratory failure in our hospital from June 2014 to June 2019 were selected， they were divided into control group and study group according to the random number table method， 45 cases in each group. The control group was treated with conventional treatment， and the study group was treated with noninvasive positive pressure ventilation on the basis of control group. The curative effect after 2 weeks of treatment were compared between two groups， and the serum inflammatory factors （hs-CRP， PCT， IL-33， IL-17， SICAM-1）， blood gas analysis （PaO2， PaCO2）， lung function （FEV1， FVC， FEV1/FVC%）， vital signs （heart rate， respiratory rate， blood oxygen saturation） before and after 2 weeks of treatment were compared between two groups. Result： The total effective rate of study group was higher than that of control group， the difference was statistically significant （P<0.05）. Before treatment， there were no significant differences in the levels of hs-CRP， PCT， IL-33， IL-17 and SICAM-1 between two groups （P>0.05）; after 2 weeks of treatment， the levels of hs-CRP， PCT， IL-33， IL-17 and SICAM-1 of both groups were lower than before treatment， and those of study group were lower than those of control group， the differences were statistically significant （P<0.05）. Before treatment， there were no significant differences in the levels of PaO2， PaCO2， FEV1， FVC and FEV1/FVC% between two groups （P>0.05）; after 2 weeks of treatment， the levels of PaO2， PaCO2， FEV1， FVC and FEV1/FVC% of both groups were superior than before treatment， and those of study group were superior than those of control group， the differences were statistically significant （P<0.05）. Before treatment， there were no statistical significant differences in heart rate， respiratory rate and blood oxygen saturation level between two groups （P>0.05）; after 2 weeks of treatment， heart rate， respiratory rate and blood oxygen saturation of two groups were superior than before treatment， and those of study group were superior than those of control group， the differences were statistically significant （P<0.05）. Conclusion： The application of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease complicated with respiratory failure has higher value and better effect， which can effectively improve the blood gas analysis， lung function and vital signs level of patients， reduce inflammatory reaction， and has important significance for promoting rehabilitation.

[Key words] Noninvasive positive pressure ventilation Chronic obstructive pulmonary disease Respiratory failure Serum inflammatory factors

First-author’s address： Zaozhuang Municipal Hospital， Zaozhuang 277001， China

doi：10.3969/j.issn.1674-4985.2021.19.019

慢性阻塞性肺疾病是臨床上一种常见疾病，主要累及患者的肺部，表现为持续存在的气流受限以及相关的呼吸系统症状，但该病的发病率、复发率、病死率均较高，严重影响了患者的生命安全以及日常的生活质量[1]。……