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目的观察BiPAP无创通气联合特布他林、氨溴索治疗重度慢性阻塞性肺疾病(COPD)患者的临床效果。方法选取2014年6月—2015年10月在解放军第四七四医院呼吸内科接受治疗的重度COPD患者100例为观察对象,并根据其治疗方式分为2组。对照组(45例)行BiPAP无创通气,观察组(55例),在无创通气基础上予特布他林、氨溴索治疗。观察2组患者的治疗效果,治疗前后肺功能、血气指标和血清炎性细胞因子水平的差异,记录不良反应的情况。结果观察组治疗的总有效率明显高于对照组(98.2%vs.84.4%,χ~2=6.346,P=0.012);治疗前2组患者的肺功能指标6分钟步行试验(6MWT)、用力肺活量(FVC)、一秒用力呼气容积(FEV_1)、FEV_1/FVC、最大呼气中段流量(MMEF)和峰值呼气流速(PEF)以及血气指标PaO_2、pH和PaCO_2水平差异无统计学意义(P>0.05),治疗后,2组患者的肺功能指标和PaO_2、pH均较治疗前增高,PaCO_2均较治疗前降低,而观察组变化较对照组更为明显(P<0.05);治疗前,2组患者的IL-8、IL-17、hs-CRP、TNF-α等指标无明显差别(P>0.05),治疗后,2组患者的上述指标均较治疗前下降,且观察组较对照组下降更为明显(P<0.05)。2组患者均无不良反应发生。结论 BiPAP无创通气联合特布他林、氨溴索对重度COPD患者有较好的治疗效果,可明显改善患者的肺功能和血气水平。
Objective To observe the clinical effect of BiPAP non-invasive ventilation combined with terbutaline and ambroxol in patients with severe chronic obstructive pulmonary disease (COPD). Methods From June 2014 to October 2015, 100 patients with severe COPD undergoing respiratory medicine in the 474 Hospital of PLA were enrolled and divided into 2 groups according to their treatment. The control group (n = 45) received BiPAP non-invasive ventilation. The observation group (n = 55) was treated with terbutaline and ambroxol on the basis of non-invasive ventilation. To observe the treatment effect of two groups of patients, before and after treatment of lung function, blood gas levels and serum levels of inflammatory cytokines, record the adverse reactions. Results The total effective rate of the observation group was significantly higher than that of the control group (98.2% vs 84.4%, χ ~ 2 = 6.346, P = 0.012). The 6-minute walking test (6MWT) FVC, FEV_1, FEV_1 / FVC, MMEF and PEF, as well as PaO_2, pH and PaCO_2 were not significantly different between the two groups P <0.05). After treatment, the pulmonary function indexes and PaO_2, pH of two groups were higher than those before treatment, PaCO_2 were lower than those before treatment, while the changes in observation group were more obvious than those in control group (P <0.05) The levels of IL-8, IL-17, hs-CRP and TNF-αin the two groups had no significant difference (P> 0.05). After treatment, the above indexes of the two groups were all lower than those before treatment, The control group decreased more significantly (P <0.05). No adverse reactions occurred in both groups. Conclusion BiPAP noninvasive ventilation combined with terbutaline, ambroxol has a good therapeutic effect in patients with severe COPD, can significantly improve the patient’s lung function and blood gas levels.