无创正压通气对急性加重期 COPD 患者痰液及血液炎性因子水平的影响

摘要

Objective To further explore the mechanism of the non-invasive positive pressure ventilation ( NPPV) in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods Thirty cases of AECOPD patients were randomly divided into the NPPV group and control group with 15 cases in each .Patients in the two groups were given conventional treatment for AECOPD , on the basis of this , the NPPV group was treated by NPPV therapy .Before and 72 hours after treatment , the Medical Research Council Dyspnea Scale ( MRC) score and artery blood gas indexes in the two groups were evaluated , and we collected the sputum samples for determination of interleukin-6 ( IL-6), IL-8 and tumor necrosis factor-α(TNF-α) levels.Results Breathing difficulties were significantly alleviated and ar-terial blood gas results were improved in the two groups after treatment , especially in the NPPV group (all P<0.05);IL-6, IL-8 and TNF-αlevels in the sputum were decreased as compared with that before treatment in the two groups , especial-ly in the NPPV group (all P<0.05).Conclusion NPPV may reduce the systemic inflammatory response and relieve dyspnea of AECOPD patients through the inhibition of cytokines , inflammatory cells and the corresponding markers .%目的：观察无创正压通气（ NPPV）对慢性阻塞性肺疾病急性加重期（ AECOPD ）患者痰液及血液中炎性因子水平的影响，探讨NPPV治疗和机制。方法将30例AECOPD患者随机分为NPPV组和对照组各15例，两组均予常规AECOPD治疗药物，在此基础上NPPV组辅助NPPV治疗。分别于治疗前和治疗72 h后评价两组医学研究会呼吸困难量表（ MRC）评分、动脉血气指标，收集痰及空腹静脉血标本测定IL-6、IL-8、肿瘤坏死因子（ TNF）-α含量。结果两组治疗后呼吸困难均缓解、动脉血气指标均改善，尤以NPPV组为著（P均＜0．05）；两组治疗后痰液及血液中IL-6、IL-8、TNF-α水平均较治疗前下降，尤以NPPV组为著（ P均＜0．05）。结论 NPPV治疗后AE-COPD患者痰液及血液中炎性因子水平下调，此可能为NPPV治疗AECOPD的机制之一。