BiPAP联合百令胶囊对COPD并发Ⅱ型呼吸衰竭患者血气指标和心肺功能的影响
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摘要
目的:观察双水平气道正压(BiPAP)通气联合百令胶囊对慢性阻塞性肺疾病(COPD)并发Ⅱ型呼吸衰竭患者血气指标和肺功能的影响。方法:104例COPD合并Ⅱ型呼吸衰竭患者分为观察组(n=48)和对照组(n=56),对照组采用BiPAP通气治疗,观察组采用BiPAP通气联合百令胶囊治疗;于治疗前、治疗2周及治疗8周时,采用动脉血气分析仪检测两组患者外周动脉血血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、动脉血氧饱和度(SaO_2)、pH值,采用肺功能检测仪检测第一秒用力呼气容积(FEV1)、FEV1与用力呼气肺活量(FVC)比值(FEV1/FVC)、呼气峰值流速占预计值比(PEF%);于治疗前及治疗8周时采用流式细胞术检测两组患者外周血T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)指标,采用酶联免疫法检测血清转化生长因子(TGF-β1)、基质金属蛋白酶-9(MMP-9)及金属蛋白酶组织抑制因子-1(TIMP-1)水平;比较两组患者治疗2周和8周时的治疗效果。结果:治疗2周及8周时,两组患者PaO_2、SaO_2、pH、FEV1、FEV1/FVC及PEF%均显著高于治疗前,PaCO_2显著低于治疗前(P<0.05),观察组PaO_2、PaCO_2、SaO_2变化显著大于对照组同时间点(P<0.05);治疗8周时,观察组FEV1、FEV1/FVC及PEF%显著高于治疗2周时(P<0.05),两组患者CD3+、CD4+、CD4+/CD8+均显著高于治疗前(P<0.05),TGF-β1、MMP-9显著低于治疗前、TIMP-1显著高于治疗前(P<0.05),且观察组上述指标变化显著大于对照组(P<0.05);观察组治疗2周和治疗8周时的总有效率(87.50%、95.83%)均显著高于对照组同时间点的总有效率(69.64%、75.00%,P<0.05)。结论:BiPAP通气联合百令胶囊治疗COPD并发Ⅱ型呼衰能有效改善患者血气指标、肺功能、免疫功能及炎性水平,提高临床疗效。
Objective:To observe the effects of bilevel positive airway pressure(BiPAP) ventilation combined with Bailing capsule on blood gas indexes and cardiopulmonary function in patients with chronic obstructive pulmonary disease(COPD) complicated with type Ⅱ respiratory failure.Methods:Patients with COPD complicated with type Ⅱ respiratory failure were divided into observation group(n= 48) and control group(n=56).The control group was treated with BiPAP ventilation,and the observation group was treated with BiPAP ventilation combined with Bailing capsule.Before treatment and after 2 and 8 weeks treatment,peripheral arterial partial pressure of oxygen(PaO_2),partial pressure of carbon dioxide(PaCO_2),arterial oxygen saturation(SaO_2) and pH value were measured by arterial blood gas analyzer.The forced breath volume(FEV1),the ratio of FEV1 to forced vital capacity(FEV1/FVC) and the ratio of peak flow velocity to predicted value(PEF%) were measured by pulmonary function detector.Peripheral blood T lymphocyte subsets(CD3+,CD4+,CD4+/CD8+)were measured by flow cytometry before treatment and after 8 weeks treatment,and the levels of serum transforming growth factor(TGF-β1),matrix metalloprotease-9(MMP-9) and tissue inhibitor of metalloprotease-1(TIMP-1) were measured by enzyme-linked immunosorbent assay(Elisa).The therapeutic effects were compared between the two groups at 2 and 8 weeks.Results:At 2 and 8 weeks of treatment,PaO_2,SaO_2,pH,FEV1,FEV1/FVC and PEF% in both groups were significantly higher than those before treatment,and PaCO_2 was significantly lower than that before treatment(P<0.05).The change of PaO_2,PaCO_2 and SaO_2 in the observation group was significantly higher than that in the control group at the same time(P<0.05).At 8 weeks of treatment,FEV1,FEV1/FVC and PEF% in the observation group were significantly higher than those at the second week of treatment(P<0.05),and CD3+,CD4+and CD4+/CD8+in both groups were significantly higher than those before treatment(P<0.05).TGF-β1 and MMP-9 were significantly lower than those before treatment,and TIMP-1 was significantly higher than that before treatment(P<0.05).The changes of the above indexes in the observation group were significantly higher than those in the control group(P<0.05).The total effective rate of 2 and 8 weeks of treatment in the observation group(87.50%,95.83%) was significantly higher than that in the control group(69.64%,75.00%,P<0.05) at the same time.Conclusion:BiPAP ventilation combined with Bailing capsule can effectively improve the blood gas index,pulmonary function,immune function and inflammatory level of patients with COPD complicated with type Ⅱ respiratory failure,and improve the clinical efficacy.
Objective:To observe the effects of bilevel positive airway pressure(BiPAP) ventilation combined with Bailing capsule on blood gas indexes and cardiopulmonary function in patients with chronic obstructive pulmonary disease(COPD) complicated with type Ⅱ respiratory failure.Methods:Patients with COPD complicated with type Ⅱ respiratory failure were divided into observation group(n= 48) and control group(n=56).The control group was treated with BiPAP ventilation,and the observation group was treated with BiPAP ventilation combined with Bailing capsule.Before treatment and after 2 and 8 weeks treatment,peripheral arterial partial pressure of oxygen(PaO_2),partial pressure of carbon dioxide(PaCO_2),arterial oxygen saturation(SaO_2) and pH value were measured by arterial blood gas analyzer.The forced breath volume(FEV1),the ratio of FEV1 to forced vital capacity(FEV1/FVC) and the ratio of peak flow velocity to predicted value(PEF%) were measured by pulmonary function detector.Peripheral blood T lymphocyte subsets(CD3+,CD4+,CD4+/CD8+)were measured by flow cytometry before treatment and after 8 weeks treatment,and the levels of serum transforming growth factor(TGF-β1),matrix metalloprotease-9(MMP-9) and tissue inhibitor of metalloprotease-1(TIMP-1) were measured by enzyme-linked immunosorbent assay(Elisa).The therapeutic effects were compared between the two groups at 2 and 8 weeks.Results:At 2 and 8 weeks of treatment,PaO_2,SaO_2,pH,FEV1,FEV1/FVC and PEF% in both groups were significantly higher than those before treatment,and PaCO_2 was significantly lower than that before treatment(P<0.05).The change of PaO_2,PaCO_2 and SaO_2 in the observation group was significantly higher than that in the control group at the same time(P<0.05).At 8 weeks of treatment,FEV1,FEV1/FVC and PEF% in the observation group were significantly higher than those at the second week of treatment(P<0.05),and CD3+,CD4+and CD4+/CD8+in both groups were significantly higher than those before treatment(P<0.05).TGF-β1 and MMP-9 were significantly lower than those before treatment,and TIMP-1 was significantly higher than that before treatment(P<0.05).The changes of the above indexes in the observation group were significantly higher than those in the control group(P<0.05).The total effective rate of 2 and 8 weeks of treatment in the observation group(87.50%,95.83%) was significantly higher than that in the control group(69.64%,75.00%,P<0.05) at the same time.Conclusion:BiPAP ventilation combined with Bailing capsule can effectively improve the blood gas index,pulmonary function,immune function and inflammatory level of patients with COPD complicated with type Ⅱ respiratory failure,and improve the clinical efficacy.
引文
[1]张园,郝璐.异丙托溴铵治疗COPD患者前后血清炎症因子水平、肺功能的变化及临床意义[J].标记免疫分析与临床,2018,25(3):416-420.
[2]朱幼鸣,胡辉,曾烨.无创正压通气辅助治疗对COPD合并Ⅱ型呼吸衰竭患者血气参数、心功能及炎症状态的影响[J].海南医学院学报,2017,23(3):327-330.
[3]陈辉,朱少文,邓小琴,等.无创正压通气对AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP水平的影响[J].贵州医科大学学报,2017,42(6):736-740.
[4]王丽丽,冯轩,崔婷婷.百令胶囊联合呼吸康复训练治疗慢阻肺的疗效及对患者血气指标、肺功能的影响[J].世界中医药,2017,12(12):2949-2952.
[5]薛智文,李英.百令胶囊对肺肾两虚型慢性阻塞性肺疾病患者BODE指数、生活质量及对外周血TGF-β、MMP-9/TIMP-1表达的影响[J].现代中西医结合杂志,2018,27(25):2822-2825.
[6]袁晓梅,李华旭,高新愿.百令胶囊对慢性阻塞性肺疾病稳定期患者的干预效果[J].新乡医学院学报,2018,35(1):42-44.
[7]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].全科医学临床与教育,2013,6(5):484-491.
[8]国家中医药管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:219.
[9]孙蕾艳,程帆.多沙普仑联合Bi PAP无创呼吸机治疗COPD并Ⅱ型呼吸衰竭疗效及对血清PARC/CCL18的影响[J].中国临床研究,2018,31(8):1047-1050.
[10]王锋,李林,刘璐,等.乌司他丁联合BIPAP呼吸机对慢性阻塞性肺气肿合并呼吸衰竭患者疗效及预后的影响[J].成都医学院学报,2018,13(1):50-53.
[11]袁壮军,赵燕,周梅芳.乌司他丁联合双水平气道正压通气治疗慢性阻塞性肺疾病并Ⅱ型呼吸衰竭的临床疗效[J].实用心脑肺血管病杂志,2018,26(8):96-99.
[12]苗润丰,方蕾,刘大禹.无创正压通气联合尼可刹米治疗AECOPD并Ⅱ型呼吸衰竭的临床疗效[J].贵州医科大学学报,2017,42(10):81-85.
[13]刘杨. Bi PAP治疗慢阻肺老年患者并发呼吸衰竭对血气水平的影响及并发症分析[J].临床肺科杂志,2017,22(10):1833-1836.
[14]孙砚诚,林振怀,王永仓,等.双水平气道正压通气(BIPAP)呼吸机治疗COPD并Ⅱ型呼吸衰竭患者的疗效评估[J].现代生物医学进展,2017,17(14):2703-2706.
[15]洪敏俐,郭媛媛,黄锦榕,等.慢性阻塞性肺疾病不同表型中医证型分布规律探讨[J].中华中医药杂志,2018,33(3):1194-1197.
[16]许惠娟,李时悦.百令胶囊的药理作用及其在肺部疾病的研究进展[J].中国中药杂志,2010,35(20):2777-2781.
[17]孙颖.百令胶囊联合信必可对中重度慢性阻塞性肺疾病患者肺功能及氧化应激的影响[J].海南医学,2017,28(24):3980-3982.
[18]荣辉,丁念,周黎.滋金补水膏参与老年慢阻肺治疗的临床研究[J].湖北中医药大学学报,2017,19(2):23-26.
[19]吴刚.慢性阻塞性肺疾病患者血清基质金属蛋白酶、VEGF水平的变化及其临床意义[J].临床肺科杂志,2018,23(1):79-83.
[20]郑石洲,何康,彭敏,等.百令胶囊联合孟鲁司特钠对慢性阻塞性肺疾病患者呼吸功能和免疫功能的影响[J].广州中医药大学学报,2018,35(4):610-614.
[2]朱幼鸣,胡辉,曾烨.无创正压通气辅助治疗对COPD合并Ⅱ型呼吸衰竭患者血气参数、心功能及炎症状态的影响[J].海南医学院学报,2017,23(3):327-330.
[3]陈辉,朱少文,邓小琴,等.无创正压通气对AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP水平的影响[J].贵州医科大学学报,2017,42(6):736-740.
[4]王丽丽,冯轩,崔婷婷.百令胶囊联合呼吸康复训练治疗慢阻肺的疗效及对患者血气指标、肺功能的影响[J].世界中医药,2017,12(12):2949-2952.
[5]薛智文,李英.百令胶囊对肺肾两虚型慢性阻塞性肺疾病患者BODE指数、生活质量及对外周血TGF-β、MMP-9/TIMP-1表达的影响[J].现代中西医结合杂志,2018,27(25):2822-2825.
[6]袁晓梅,李华旭,高新愿.百令胶囊对慢性阻塞性肺疾病稳定期患者的干预效果[J].新乡医学院学报,2018,35(1):42-44.
[7]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].全科医学临床与教育,2013,6(5):484-491.
[8]国家中医药管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:219.
[9]孙蕾艳,程帆.多沙普仑联合Bi PAP无创呼吸机治疗COPD并Ⅱ型呼吸衰竭疗效及对血清PARC/CCL18的影响[J].中国临床研究,2018,31(8):1047-1050.
[10]王锋,李林,刘璐,等.乌司他丁联合BIPAP呼吸机对慢性阻塞性肺气肿合并呼吸衰竭患者疗效及预后的影响[J].成都医学院学报,2018,13(1):50-53.
[11]袁壮军,赵燕,周梅芳.乌司他丁联合双水平气道正压通气治疗慢性阻塞性肺疾病并Ⅱ型呼吸衰竭的临床疗效[J].实用心脑肺血管病杂志,2018,26(8):96-99.
[12]苗润丰,方蕾,刘大禹.无创正压通气联合尼可刹米治疗AECOPD并Ⅱ型呼吸衰竭的临床疗效[J].贵州医科大学学报,2017,42(10):81-85.
[13]刘杨. Bi PAP治疗慢阻肺老年患者并发呼吸衰竭对血气水平的影响及并发症分析[J].临床肺科杂志,2017,22(10):1833-1836.
[14]孙砚诚,林振怀,王永仓,等.双水平气道正压通气(BIPAP)呼吸机治疗COPD并Ⅱ型呼吸衰竭患者的疗效评估[J].现代生物医学进展,2017,17(14):2703-2706.
[15]洪敏俐,郭媛媛,黄锦榕,等.慢性阻塞性肺疾病不同表型中医证型分布规律探讨[J].中华中医药杂志,2018,33(3):1194-1197.
[16]许惠娟,李时悦.百令胶囊的药理作用及其在肺部疾病的研究进展[J].中国中药杂志,2010,35(20):2777-2781.
[17]孙颖.百令胶囊联合信必可对中重度慢性阻塞性肺疾病患者肺功能及氧化应激的影响[J].海南医学,2017,28(24):3980-3982.
[18]荣辉,丁念,周黎.滋金补水膏参与老年慢阻肺治疗的临床研究[J].湖北中医药大学学报,2017,19(2):23-26.
[19]吴刚.慢性阻塞性肺疾病患者血清基质金属蛋白酶、VEGF水平的变化及其临床意义[J].临床肺科杂志,2018,23(1):79-83.
[20]郑石洲,何康,彭敏,等.百令胶囊联合孟鲁司特钠对慢性阻塞性肺疾病患者呼吸功能和免疫功能的影响[J].广州中医药大学学报,2018,35(4):610-614.