抗凝联合平均容积保证压力支持模式对慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的治疗效果  

Effect of anticoagulation combined with average volumeassuredpressuresupporton acute exacerbation of chronic obstructive pulmonary disease patients with typeⅡrespiratory failure

作　　者：黄泽燕[1] 吴亚 侯亚平 李松桃[3] Huang Zeyan;Wu Ya;Hou Yaping;Li Songtao(Department of Critical Care Medicine,Second People1 s Hospital of Xindu District,Chengdu 610501,China;Department of Respiratory Medicine,Sichuan Provincial People's Hospital,Chengdu 610501,China;Department of Respiratory Medicine,Chengdu Sixth People's Hospital,Chengdu 610501,China)

机构地区：[1]成都市新都区第二人民医院重症医学科,610501 [2]四川省人民医院呼吸科,成都610501 [3]成都市第六人民医院呼吸科,610501

出　　处：《中国医师进修杂志》2021年第12期1119-1124,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨低分子肝素联合平均容积保证压力支持(AVAPS)模式对慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者的治疗效果。方法选取2018年2月至2020年4月成都市新都区第二人民医院收治的82例AECOPD合并Ⅱ型呼吸衰竭患者作为研究对象,按随机数字表法分为对照组和观察组,每组41例。对照组在常规治疗基础上予以AVAPS模式,观察组在常规治疗基础上予以低分子肝素联合AVAPS模式。比较两组治疗前后动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大呼气峰流速(PEF)、白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)、人克拉拉细胞蛋白(CC16)、表面活性蛋白D(SP-D)、脂联素(APN)、超氧化物歧化酶(SOD)、D-二聚体、纤维蛋白原水平及不良反应发生率。结果观察组治疗后FEV1、FVC、PEF、PaO2水平高于对照组[(1.78±0.29)L比(1.47±0.25)L、(2.47±0.29)L比(2.20±0.25)L、(5.14±0.37)ml/s比(4.69±0.35)ml/s、(88.37±10.52)mmHg(1 mmHg=0.133 kPa)比(80.16±9.87)mmHg],PaCO_(2)水平低于对照组[(65.07±6.71)mmHg比(70.84±6.50)mmHg],差异有统计学意义(P<0.05);观察组治疗后IL-6、IL-8、TNF-α水平低于对照组[(0.47±0.09)ng/L比(0.58±0.10)ng/L、(64.37±7.25)ng/L比(88.24±8.34)ng/L、(45.37±4.63)ng/L比(66.31±4.92)ng/L],SOD、APN水平高于对照组[(92.37±10.85)U/mg比(76.13±9.84)U/mg、(13.94±0.76)mg/L比(11.58±1.21)mg/L],差异有统计学意义(P<0.05);观察组治疗后CC16水平高于对照组[(114.78±12.15)μg/L比(107.41±11.06)μg/L],SP-D、D-二聚体、纤维蛋白原水平低于对照组[(93.24±9.85)μg/L比(103.25±10.78)μg/L、(0.58±0.07)mg/L比(0.79±0.11)mg/L、(1.98±0.29)g/L比(2.56±0.34)g/L],差异有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论低分子肝素联合AVAPS模式治疗AECOPD合并Ⅱ型呼吸衰竭,可显著改善患者肺部炎性反应�Objective to investigate the therapeutic effect of low molecular weight heparin combined with average volumeassuredpressuresupport(AVAPS)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with typeⅡrespiratory failure.Methods A total of 82 patients with AECOPD combined with typeⅡrespiratory failure in the Second People′s Hospital of Xindu District of Chengdu from February 2018 to April 2020 were selected as the research objects,and they were randomly divided into two groups with 41 cases in each group.The control group was given AVAPS mode,and the observation group was given low molecular weight heparin combined with AVAPS mode.The arterial partial pressure of oxygen(PaO_(2)),arterial carbon dioxide(PaCO_(2)),and forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),maximum peak expiratory flow rate(PEF),interleukin(IL)-6,IL-8,tumor necrosis factor-(TNF-α),16 kDa Clara cell protein(CC16),surfactant protein D(SP-D),adiponectin(APN),superoxide dismutase(SOD),D-dimer,fibrinogen before and after treatment were compared between the two groups and the incidence of adverse reactions were observed.Results After treatment,the levels of FEV1,FVC,PEF,PaO_(2) in the observation group were higher than those in the control group:(1.78±0.29)L vs.(1.47±0.25)L,(2.47±0.29)L vs.(2.20±0.25)L,(5.14±0.37)ml/s vs.(4.69±0.35)ml/s,(88.37±10.52)mmHg(1 mmHg=0.133 kPa)vs.(80.16±9.87)mmHg;and the level of PaCO_(2) was lower than that in the control group:(65.07±6.71)mmHg vs.(70.84±6.50)mmHg;and the differences were statistically significant(P<0.05).After treatment,the levels of IL-6,IL-8 and TNF-αin the observation group were lower than those in the control group:(0.47±0.09)ng/L vs.(0.58±0.10)ng/L,(64.37±7.25)ng/L vs.(88.24±8.34)ng/L,(45.37±4.63)ng/L vs.(66.31±4.92)ng/L;and the levels of SOD and APN were higher than those in the control group:(92.37±10.85)U/mg vs.(76.13±9.84)U/mg,(13.94±0.76)mg/L vs.(11.58±1.21)mg/L;and the differences were stati

关 键 词：肺疾病 慢性阻塞性 呼吸功能不全 肝素 低分子量 平均容积保证压力支持 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]