无创正压通气治疗时机对慢阻肺合并呼吸衰竭者疗效及骨骼肌泛素-蛋白酶体表达的影响

摘要

目的 分析无创正压通气治疗时机对慢阻肺合并呼吸衰竭者骨骼肌泛素-蛋白酶体表达的影响.方法 选取2014年2月-2016年2月收入我院的156例慢阻肺合并呼吸衰竭患者,根据患者意愿分为早期治疗的A组65例,延迟治疗的B组52例,另选择同期常规对症支持治疗的39例患者设为对照组C组.C组患者在入院后,采取基础治疗.A组和B组患者在此基础上采取NPPV治疗.观察三组患者的疗效、预后、炎症指标和骨豁肌内基因表达水平.结果 与治疗前相比,A组、B组和C组患者的pH、PaO2明显升高,呼吸和HR明显降低,对比分析后,差异有统计学意义(P<0.05),与B组患者相比,治疗后A组患者的pH、PaO2明显更高,呼吸和HR明显更低,对比分析后,差异有统计学意义(t=2.890、2.052、5.708、2.638,P<0.05).与治疗前相比,A组、B组和C组患者痰液、血液中的IL-6、IL-8和TNF-α指标明显改善,与B组患者相比,治疗后A组患者痰液、血液中的IL-6、IL-8和TNF-α明显更低,差异有统计学意义(P<0.05).A组骨骼肌内核糖体蛋白S21、泛素、E2及E3的mRNA表达最低,其次为B组,C组患者的RPS21、泛素、E2及E3表达最高,对比分析后,差异有统计学意义(F=8.302、5.346、5.093、4.783,P<0.05).结论 NPPV对于慢阻肺合并呼吸衰竭患者可有效纠正缺氧,减少住院时间,降低死亡率,并且早期接受治疗,患者的疗效更好,可有效降低患者的呼吸肌肉负荷,完善骨骼肌蛋白酶体途径,减少骨骼肌蛋白质丢失,进而提高慢阻肺合并呼吸衰竭患者的通气、氧合状态.%Objective To analyze the effect of non-invasive positive pressure ventilation on skeletal ubiquitin-proteasome expression of patients with COPD and respiratory failure.Methods 156 cases of patients with COPD and respiratory failure were selected in our hospital from February 2014 to February 2016.According to the patient''s wishes, 65 cases were divided into the group A (n=52) and the group B (n=52).The other 39 cases who were treated by conventional symptomatic support were selected as the control group.The group C was given basic treatment after admission, and the group A and the group B were treated with NPPV.The curative effect, prognosis, inflammation index and gene expression level were observed in the three groups.Results The value of pH and PaO2 was significantly higher, and respiration and HR were lower after treatment in the three groups (P<0.05).The value of pH and PaO2 was significantly higher, and respiration and HR were significantly lower in the group A than in the group B (t=2.890, 2.052, 5.708, 2.638, P<0.05). The levels of IL-6, IL-8 and TNF-α in sputum and blood improved significantly after treatment, and they were significantly lower in the group A than in the group B (P<0.05).The mRNA expression of S22, ubiquitin, E2 and E3 in skeletal muscle of the group A was the lowest, followed by the group B and the group C (F=8.302, 5.346, 5.093, 4.783, P<0.05).Conclusion NPPV can effectively reduce hypoxia, hospitalization time and mortality in patients with COPD complicated with respiratory failure.The early treatment can get better efficacy, effectively reduce the patient''s respiratory muscle load, improve the skeletal muscle proteasome pathway, reduce bone Muscle protein loss and improve COPD patients and respiratory failure in the ventilation, oxygenation status.