甲泼尼龙联合双水平气道正压通气治疗重症呼吸衰竭患者的疗效及其对免疫功能的影响  

Effects of methylprednisolone combined with BiPAP on the efficacy and immune function in treating the patients with severe respiratory failure

作　　者：杨薇薇[1] 杨希[2] YANG Weiwei;YANG Xi(Department of Respiratory Medicine,Taizhou Central Hospital,Taizhou 318000,CHINA)

机构地区：[1]台州市中心医院呼吸内科,浙江318000 [2]台州市中心医院呼吸与危重症医学科,浙江318000

出　　处：《江苏医药》2023年第9期891-894,共4页Jiangsu Medical Journal

基　　金：浙江省中医药科技计划(2018ZB135)。

摘　　要：目的探讨甲泼尼龙联合双水平气道正压通气(BiPAP)治疗重症呼吸衰竭的疗效极其对免疫功能的影响。方法108例重症呼吸衰竭患者随机均分为两组。BiPAP组采用BiPAP治疗;联合治疗组在BiPAP组基础上加用甲泼尼龙0.5~1.0 mg·kg^(-1)·d^(-1)静脉滴注,连续治疗3 d。比较两组治疗前后血气分析参数、肺功能指标和T淋巴细胞亚群水平的变化,比较两组临床疗效和不良反应发生率。结果治疗前两组血气分析参数、肺功能指标和T淋巴细胞亚群水平均无统计学差异(P>0.05)。与治疗前相比,治疗后两组HR和RR减慢(P<0.05),pH、PaO_(2)、用力肺活量、第1秒用力呼气容积、最大呼气流量和CD3^(+)T淋巴细胞百分比上升(P<0.05),PaCO_(2)和CD4^(+)T淋巴细胞百分比下降(P<0.05),且联合治疗组上述指标改变更明显(P<0.05)。联合治疗组总有效率高于BiPAP组(94.44%vs.81.48%)(P<0.05),不良反应发生率稍低于BiPAP组(P>0.05)。结论与单用BiPAP治疗相比,甲泼尼龙联合BiPAP对重症呼吸衰竭患者的疗效更好,肺功能和免疫功能改善更明显。Objective To explore the effects of methylprednisolone combined with bi-level positive airway pressure(BiPAP)on the efficacy and immune function in treating the patients with severe respiratory failure.Methods A total of 108 patients with severe respiratory failure were equally randomized into two groups.Group C was treated with BiPAP.On the basis of group C,group A received intravenous infusion of methylprednisolone 0.5-1.0 mg·kg^(-1)·d^(-1)for 3 days.The changes of blood gas analysis parameters,lung function indicators,and T lymphocyte subset levels before and after treatment were compared between the two groups.The clinical efficacy and incidence of adverse reactions were compared between the two groups.Results There were no significant differences in blood gas analysis parameters,lung function indicators,and T lymphocyte subset levels between the two groups before treatment(P<0.05).Compared with before treatment,HR and RR were slower(P<0.05),pH,PaO_(2),forced vital capacity,forced expiratory volume in the first second,maximum expiratory flow and percentage of CD3^(+)T lymphocytes were higher(P<0.05),while PaCO_(2)and percentage of CD4^(+)T lymphocytes were lower in the two groups after treatment(P<0.05),which were more obvious in group A(P<0.05).The overall effectiveness rate of group A was higher than that of group C(94.44%vs.81.48%)(P<0.05).The incidence of adverse reactions was slightly lower in group A than that in group C(P>0.05).Conclusion Compared with BiPAP alone,the combination of methylprednisolone and BiPAP has a better therapeutic efficacy with more obvious improvements in lung function and immune function in the patients with severe respiratory failure.

关 键 词：甲泼尼龙 双水平气道正压通气 呼吸衰竭 肺功能 免疫功能 

分 类 号：R563[医药卫生—呼吸系统]