乙酰半胱氨酸雾化吸入配合无创呼吸机NIPSV模式通过调节免疫炎症反应治疗AECOPD合并呼吸衰竭的机制  

The Mechanism of Acetylcysteine Aerosol Inhalation Combined with Non-invasive Ventilator NIPSV Mode in the Treatment of AECOPD with Respiratory Failure by Regulating Immune Inflammatory Response

作　　者：张维华 秦珊珊 温思聪 吴平宇 宋昭光 ZHANG Weihua;QIN Shanshan;WEN Sicong;WU Pingyu;SONG Zhaoguang(Dept.of Critical Care Medicine,Tongcheng People’s Hospital of Anhui Province,Tongcheng Anhui 231400,China)

机构地区：[1]安徽省桐城市人民医院重症医学科,安徽桐城231400

出　　处：《昆明医科大学学报》2024年第7期113-118,共6页Journal of Kunming Medical University

基　　金：安徽省卫生厅医药科研计划基金资助项目(12925KJ2017B17)。

摘　　要：目的探究乙酰半胱氨酸雾化吸入配合无创呼吸机压力支持通气(NIPSV)模式通过调节免疫炎症反应治疗慢性阻塞性肺疾病急性期(AECOPD)合并呼吸衰竭的机制。方法选取2020年2月至2022年12月于安徽省桐城市人民医院就诊的AECOPD合并呼吸衰竭患者共计80例,依据治疗方案不同分为实验组(n=42)及对照组(n=38),实验组采用无创呼吸机NIPSV模式联合乙酰半胱氨酸雾化吸入,对照组采用无创呼吸机NIPSV模式,对比2组治疗前后肺功能:包括第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC;血气指标:动脉血氧分压(PaO_(2))、动脉血二氧化碳(PaCO_(2))、血氧饱和度(SaO_(2));血清指标:白介素-6(IL-6)、淀粉样蛋白A(SAA)、C反应蛋白(CRP)、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))水平,比较治疗期间不良反应发生率。结果治疗后实验组FEV1、FVC、FEV1/FVC水平均明显高于对照组及治疗前(P<0.05);治疗后实验组PaO_(2)、PaCO_(2)、SaO_(2)水平高于对照组及治疗前(P<0.05);治疗后实验组IL-6、SAA、CRP水平低于对照组及治疗前(P<0.05);治疗后2组CD3^(+)、CD4^(+)水平均升高,实验组高于对照组,CD8^(+)水平降低,实验组低于对照组(P<0.05);实验组不良反应发生率明显低于对照组(P<0.05)。结论AECOPD合并呼吸衰竭患者无创呼吸机NIPSV模式联合乙酰半胱氨酸吸入通过调节免疫炎症反应治疗后,能有效减轻炎性反应,提高肺功能及免疫功能的同时改善患者的血气指标。Objective To explore the mechanism of acetylcysteine aerosol inhalation combined with noninvasive ventilator pressure supported ventilation(NIPSV)in the treatment of acute stage of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure by regulating the immune inflammatory response.Methods A total of 80 patients with AECOPD combined with respiratory failure who were treated in Tongcheng People's Hospital of Anhui Province from February 2020 to December 2022 were selected and divided into experimental group(n=42)and control group(n=38)according to different treatment plans.The experimental group was treated with NIPSV mode combined with acetyl cysteine atomization inhalation.The control group was treated with non-invasive ventilator NIPSV mode.The pulmonary function of the two groups before and after treatment was compared,including forced expiratory volume(FEV1),forced vital capacity(FVC)and FEV1/FVC.Blood gas index:arterial partial pressure of oxygen(PaO_(2)),arterial carbon dioxide(PaCO_(2)),and blood oxygen saturation(SaO_(2));Serum indicators:Interleukin-6(IL-6),amyloid A(SAA),C-reactive protein(CRP),T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))levels,and the incidence of adverse reactions during treatment were compared.Results After treatment,the levels of FEV1,FVC and FEV1/FVC in experimental group were significantly higher than those in control group and before treatment(P<0.05).After treatment,PaO_(2),PaCO_(2) and SaO_(2) levels in the experimental group were higher than those in the control group and before treatment(P<0.05).The levels of IL-6,SAA and CRP in the experimental group after treatment were lower than those in the control group and before treatment(P<0.05).After treatment,the levels of CD3^(+)and CD4^(+)were increased in both groups,the experimental group was higher than the control group,the CD8^(+)level was lower in the experimental group than the control group(P<0.05).The incidence of adverse reactions in experimental group was significantly lower than that in con

关 键 词：慢性阻塞性肺疾病急性期 呼吸衰竭 无创呼吸机压力支持通气 乙酰半胱氨酸 

分 类 号：R563.8[医药卫生—呼吸系统]