噻托溴铵辅助治疗对COPD合并II型呼吸衰竭患者氧合功能及炎症反应的影响

摘要

目的：：探讨噻托溴铵辅助治疗对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者氧合功能及炎症反应的影响.方法：收集2012年8月~2016年1月本院收治的 COPD 合并Ⅱ型呼吸衰竭患者58例，根据单盲随机对照法分为观察组(n ＝29)、对照组(n ＝29).对照组接受临床常规治疗，观察组在常规治疗基础上加入噻托溴铵辅助治疗.治疗前和治疗后30 d 时，采用肺功能仪检测肺通气功能；采用血气分析仪检测氧合功能指标；采用酶联免疫吸附法(ELISA)测定血清炎症因子含量.结果：治疗前，两组肺通气功能、氧合功能，血清炎症因子含量差异无统计学意义(P ＞0．05).治疗30 d 后，观察组第一秒用力呼气容积(FEV1)、75％肺活量最大呼气流量(FEF75％)、呼气峰流速值(PEF)、氧合指数(PaO 2/FiO 2)、氧输送(DO 2)、氧摄取率(O 2 ER)水平显著高于对照组，氧消耗(VO 2)水平显著低于对照组(P ＜0．05)；血清白介素-1β(IL-1β)、白介素-18(IL-18)、白介素-27(IL-27)、C 反应蛋白(CRP)含量显著低于对照组(P ＜0．05).结论：噻托溴铵辅助治疗可优化 COPD 合并Ⅱ型呼吸衰竭患者的肺通气及氧合功能，减轻全身炎症反应程度.%[ABSTRACT]Objective:To explore the effect of adjuvant tiotropium bromide therapy on the oxygenation function and in-flammatory response in patients with COPD and type Ⅱ respiratory failure.Methods:A total of 58 patients with COPD and type Ⅱ respiratory failure treated in our hospital between August 2012 and January 201 6 were collected and divided into obser-vation group (n =29)and control group (n =29)according to the single blind randomized control method.Control group of pa-tients received clinical routine treatment,and observation group of patients received adjuvant tiotropium bromide treatment on the basis of routine treatment.Before treatment and 30 d after treatment,spirometer was used to determine pulmonary ventila-tion function;blood gas analyzer was used to test oxygenation function indexes;enzyme-linked immunosorbent assay (ELISA) was used to detect serum inflammatory factor levels.Results:Before treatment,differences in pulmonary ventilation function, oxygenation function and serum inflammatory factor levels were not statistically significant between two groups of patients (P>0.05).On 30 d after treatment,FEV1,FEF7 5 % ,PEF,PaO 2/FiO 2 ,DO 2 and O 2 ER levels of observation group were signif-icantly higher than those of control group while VO2 level was significantly lower than that of control group (P <0.05);serum IL-1β,IL-18,IL-27 and CRP levels were significantly lower than those of control group (P <0.05 ).Conclusions:Adjuvant tiotropium bromide treatment can optimize the pulmonary ventilation and oxygenation function and reduce systemic inflamma-tory response in patients with COPD and type Ⅱ respiratory failure.