标题：BiPAP联合经管道雾化吸入糖皮质激素治疗AECOPD合并Ⅱ型呼吸衰竭的疗效及对肺动脉压力和外周血EOS水平的影响

      作者：宋晓伟，高翔，张睿    陕西省康复医院急诊内科，陕西 西安 710065

      卷次： 2024年35卷5期

      【摘要】 目的 探究双水平正压通气(BiPAP)联合经管道雾化吸入糖皮质激素(GC)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭(T2RF)的疗效及对患者肺动脉压力(PAP)和外周血嗜酸性粒细胞(EOS)水平的影响。方法 选取2022年4月至2023年4月陕西省康复医院收治的80例AECOPD合并T2RF患者为研究对象，依据随机数表法分为接受BiPAP治疗的对照组(40例)和接受BiPAP联合经管道雾化吸入GC治疗的观察组(40例)，两组均治疗2周。比较两组患者的临床疗效以及治疗前后的肺功能、血气指标和炎症指标，并评估治疗期间两组患者的不良反应发生情况。结果 观察组患者的治疗总有效率为97.50%，明显高于对照组的80.00%，差异具有统计学意义(P<0.05)；治疗后，观察组患者的用力肺活量(FVC)、第一秒用力呼吸气容积(FEV1)分别为(1.99±0.53) L、(2.55±0.45) L，明显高于对照组的(1.72±0.46) L、(2.11±0.52) L，差异均有统计学意义(P<0.05)；治疗后，观察组患者的氧分压(PaO2)为(85.34±12.39) mmHg，明显高于对照组的(71.43±11.87) mmHg，二氧化碳分压(PaCO2)为(60.11±8.35) mmHg，明显低于对照组的(69.06±9.84) mmHg，差异均有统计学意义(P<0.05)；治疗后，观察组患者的白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)和EOS水平分别为(42.37±5.72) ng/L、(23.71±5.21) ng/L、(4.53±1.13)%，明显低于对照组的(51.19±6.37) ng/L、(32.63±6.01) ng/L、(8.46±2.14)%，差异均有统计学意义(P<0.05)；治疗期间，观察组患者的不良反应总发生率为10.00%，略高于对照组的5.00%，但差异无统计意义(P>0.05)。结论 BiPAP联合经管道雾化吸入GC治疗AECOPD合并T2RF可明显改善患者的肺功能指标、血气和炎症状态，临床应用效果显著且安全性较高，具有临床应用价值。
      【关键词】 慢性阻塞性肺疾病急性加重；Ⅱ型呼吸衰竭；双水平正压通气；糖皮质激素
      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2024）05—0625—05

Effect of bilevel positive airway pressure combined with aerosol inhalation of glucocorticoids via pipelines intreating AECOPD complicated with typeⅡ respiratory failure and the impact on pulmonary artery pressure andperipheral blood EOS level.
SONG Xiao-wei, GAO Xiang, ZHANG Rui. Department of Emergency Medicine, ShaanxiProvincial Rehabilitation Hospital, Xi'an 710065, Shaanxi, CHINA
【Abstract】 Objective To investigate the effect of bilevel positive airway pressure (BiPAP) combined with aero-sol inhalation of glucocorticoids (GC) via pipelines in treating acute exacerbation of chronic obstructive pulmonary dis-ease (AECOPD) complicated with type Ⅱ respiratory failure (T2RF), and the impact on pulmonary artery pressure(PAP) and peripheral blood eosinophil (EOS) level.Methods A total of 80 patients with AECOPD and T2RF who wereadmitted to Shaanxi Provincial Rehabilitation Hospital from April 2022 to April 2023 were selected as the study sub-jects. They were divided into the control group (40 patients treated with BiPAP) and the observation group (40 patientstreated with BiPAP combined with aerosol inhalation of GC via pipelines) by the random number table method. Bothgroups were treated for 2 weeks. The two groups were compared on clinical effects, pulmonary function, blood gas indi-cators, and inflammatory indicators before and after treatment. Adverse reactions that occurred during treatment wereevaluated. Results The total response rate in the observation group (97.50%) was significantly higher than that in thecontrol group (80.00%), P<0.05. After treatment, forced vital capacity (FVC) and forced expiratory volume in 1 secondin the observation group were (1.99±0.53) L and (2.55±0.45) L, significantly higher than (1.72±0.46) L and (2.11±0.52) Lin the control group (P<0.05). After treatment, partial pressure of oxygen (PaO2) in the observation group was (85.34±12.39) mmHg, significantly higher than (71.43±11.87) mmHg in the control group, and partial pressure of carbon diox-ide (PaCO2) was (60.11±8.35) mmHg, significantly lower than (69.06±9.84) mmHg in the control group, with statistical-ly significant differences (P<0.05). After treatment, the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α),and EOS in the observation group were (42.37±5.72) ng/L, (23.71±5.21) ng/L, and (4.53±1.13)%, significantly lowerthan (51.19±6.37) ng/L, (32.63±6.01) ng/L, and (8.46±2.14)% in the control group (P<0.05). The total incidence rates ofadverse reactions in the two groups were 10.00% and 5.00%, with no statistically significant difference between the twogroups (P>0.05). Conclusion The combined treatment with BiPAP and aerosol inhalation of GC via pipelines canachieve significant therapeutic effects on patients with AECOPD complicated with T2RF, which can significantly im-prove the patients’pulmonary function, blood gas, and inflammatory state, with high safety.
      【Key words】 Acute exacerbation of chronic obstructive pulmonary disease; Type Ⅱ respiratory failure; Bilevelpositive airway pressure; Glucocorticoid