沙美特罗替卡松粉吸入剂联合无创正压通气治疗老年慢性阻塞性肺疾病合并呼吸衰竭的临床效果

摘要

目的 观察沙美特罗替卡松粉吸入剂联合无创正压通气治疗老年慢性阻塞性肺疾病(COPD)合并呼吸衰竭的临床效果及安全性.方法 选取2014年1月至2016年1月解放军第三○九医院呼吸内科收治的90例确诊为COPD合并呼吸衰竭的老年患者,采用随机数字表法分为常规组和联合组,各45例.常规组采用常规支持治疗和无创正压通气治疗,联合组在常规组基础上采用沙美特罗替卡松粉吸人剂雾化吸入治疗,持续治疗7d.观察2组患者的血气指标[动脉血氧分压(PaO2)、脉搏动脉血二氧化碳分压(PaCO2)、脉搏血氧饱和度(SpO2)]、肺通气功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、FEV1占预计值百分比(FEV1％)、深吸气量、残气量、功能残气量(FRC)]以及临床疗效和不良反应发生情况.结果 经治疗后,联合组PaO2、PaCO2、SpO2、FEV1、FVC、FEV1/FVC、FEV1％、深吸气量、残气量、FRC均明显优于常规组[(92±7)mmHg(1 mmHg=0.133 kPa)比(83±8)mmHg、(37±7) mmHg比(42±7)mmHg、(96±7)％比(91±6)％、(2.49±0.35)L比(1.09±0.24)L、(3.3±0.8)L比(2.2±0.9)L、(66±10)％比(46±9)％、(68±13)％比(54±12)％、(2.88 ±0.16)L比(1.55±0.24)L、(3.96±0.88)L比(2.85±0.74)L、(3.3±0.6)L比(2.2±0.6)L](均P＜0.05).联合组总有效率明显高于常规组[93.3％ (42/45)比77.8％(35/45)](均P＜0.05).2组不良反应发生率差异无统计学意义(P＞0.05).结论 沙美特罗替卡松粉吸入剂联合无创正压通气治疗老年COPD合并呼吸衰竭可快速改善患者血气,恢复肺通气功能,疗效确切且安全性高.%Objective To analyze the effectiveness and safety of salmeterol xinafoat and fluticasone propionate powder for inhalation combined with non-invasive positive pressure ventilation in treatment of elderly patients with chronic obstructive pulmonary disease (COPD) complicated with respiratory failure.Methods A total of 90 COPD patients with respiratory failure from January 2014 to January 2016 in January in the 309th Hospital of Chinese People's Liberation Army were randomly divided into routine group and combination group,with 45 cases in each group.Both groups had supportive therapy and non-invasive positive ventilation;the combination group had salmeterol xinafoat and fluticasone propionate powder for inhalation for 7 d.Blood-gas indexes [arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),oxygen saturation(SpO2)],lung ventilation function indexes[forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),FEV1/FVC,FEV1 change in percentage predicted value(FEV1％),inspiratory capacity(IC),residual volume(RV),functional residual capacity(FRC)],clinical effective rate and adverse reactions were analyzed.Results After treatment,PaO2,PaCO2,SpO2,FEV1,FVC,FEV1/FVC,FEV1％,IC,RV and FRC in combination group were significantly better than those in routine group[(92 ±7)mmHg vs (83 ±8)mmHg,(37 ±7)mmHg vs (42 ±7)mmHg,(96 ± 7)％ vs (91 ±6)％,(2.49 ±0.35)L vs (1.09 ±0.24)L,(3.3 ±0.8)L vs (2.2 ±0.9)L,(66 ± 10)％ vs (46 ±9)％,(68 ± 13)％ vs (54 ± 12)％,(2.88 ±0.16)L vs (1.55 ±0.24) L,(3.96 ±0.88)L vs (2.85 ± 0.74)L,(3.3 ±0.6)L vs (2.2 ±0.6)L] (P ＜0.05).The total effective rate in combination group was significantly higher than that in routine group [93.3 ％ (42/45) vs 77.8 ％ (35/45)] (P ＜ 0.05).The incidence of adverse reactions had no significant difference between groups(P ＞0.05).Conclusion Salmeterol xinafoat and fluticasone propionate powder for inhalation combined with non-invasive ventilation treating elderly COPD with respiratory failure can effectively improve blood-gas and lung function with few side effects.