体外膈肌起搏联合重组人生长激素治疗重度慢性阻塞性肺疾病的效果观察  

The efficacy of external diaphragm pacing combined with recombinant human growth hormone in the treatment of severe chronic obstructive pulmonary disease

作　　者：朱永吉 沈岳松 朱慧青 Zhu Yongji;Shen Yuesong;Zhu Huiqing(Department of Critical Care Medicine,Xianju People′s Hospital(Zhejiang Southeast Campus of Zhejiang Provincial People′s Hospital)/Xianju Hospital Affiliated to Hangzhou Medical College,Taizhou 317300,China)

机构地区：[1]仙居县人民医院(浙江省人民医院浙东南院区)/杭州医学院附属仙居医院重症医学科,台州317300

出　　处：《中国医师进修杂志》2025年第2期159-163,共5页Chinese Journal of Postgraduates of Medicine

基　　金：2021年台州市第一批社会发展科技计划项目(21ywb146)。

摘　　要：目的观察体外膈肌起搏(EDP)联合重组人生长激素(rhGH)治疗重度慢性阻塞性肺疾病(COPD)的疗效。方法前瞻性选取2021年4月至2023年4月仙居县人民医院(浙江省人民医院浙东南院区)/杭州医学院附属仙居医院收治的80例重度COPD患者为研究对象,按随机数字表法分为联合组与常规组,每组40例,两组均接受抗感染、营养支持等常规治疗,联合组在常规治疗的基础上给予EDP+rhGH治疗,两组均治疗20 d。比较两组治疗前后膈肌功能、营养状况、肺功能指标及血清白细胞介素(IL)-6、IL-23、Ⅱ型肺泡细胞表面抗原(KL-6)水平,比较两组预后情况。结果联合组治疗后膈肌功能指标膈肌最大呼气压(MIP)、深吸气末膈肌厚度(DTei)、膈肌移动度(DE)水平均高于常规组[(45.36±7.04)cmH_(2)O(1 cmH_(2)O=0.098 kPa)比(42.28±6.43)cmH_(2)O、(0.32±0.12)cm比(0.27±0.06)cm、(3.40±1.02)cm比(1.85±0.64)cm],差异有统计学意义(P<0.05)。联合组治疗后营养状况指标血清白蛋白(ALB)、转铁蛋白(Tf)、总蛋白(TP)水平均高于常规组[(34.62±5.13)g/L比(31.75±4.93)g/L、(2.21±0.46)g/L比(2.00±0.42)g/L、(63.80±8.25)g/L比(60.24±6.97)g/L],差异有统计学意义(P<0.05)。联合组治疗后肺功能指标第1秒用力呼气容积(FEV_(1))占预计值百分比(FEV_(1)%)、FEV_(1)与用力肺活量比值(FEV_(1)/FVC)均高于常规组[(60.17±6.30)%比(57.25±6.24)%、(61.30±7.04)%比(57.12±7.25)%],差异有统计学意义(P<0.05)。联合组治疗后血清IL-6、IL-23、KL-6水平均低于常规组[(23.13±4.26)ng/L比(26.60±4.75)ng/L、(20.84±6.16)μg/L比(25.00±5.89)μg/L、(375.10±45.18)kU/L比(400.25±46.27)kU/L],差异有统计学意义(P<0.05)。联合组机械通气时间、重症监护室入住时间均短于常规组[(150.46±10.24)h比(189.67±15.43)h、(7.00±2.03)d比(9.84±2.72)d],差异有统计学意义(P<0.05);联合组1周内拔管率高于常规组,28 d病死率低于常规组[90.00%(36/40)比72.50%(29/40)、5.00%(2/40Objective To observe the efficacy of external diaphragm pacing(EDP)combined with recombinant human growth hormone(rhGH)in the treatment of severe chronic obstructive pulmonary disease(CDOP).Methods By the prospective study method,80 patients with severe COPD were admitted to the Xianju People′s Hospital(Zhejiang Southeast Campus of Zhejiang Provincial People′s Hospital)/Xianju Hospital Affiliated to Hangzhou Medical College from April 2021 to April 2023 were divided into the combined group and the conventional group by the random number table method,with 40 cases in each group.All of them received anti-infection,nutritional support,and other conventional treatment.In addition,the combined group was given EDP+rhGH treatment,and they were intervened for 20 d.The diaphragm function,nutrition,pulmonary function,and serum levels of interleukin(IL-6),IL-23,typeⅡalveolar cell surface antigen(KL-6)changes before and after treatment and prognosis were compared between the two groups.Results After treatment,the diaphragm function index diaphragm maximum expiratory pressure(MIP),diaphragm thickness(DTei),and diaphragm mobility(DE)in the combined group were higher than those in the conventional group:(45.36±7.04)cmH_(2)O(1 cmH_(2)O=0.098 kPa)vs.(42.28±6.43)cmH_(2)O,(0.32±0.12)cm vs.(0.27±0.06)cm,(3.40±1.02)cm vs.(1.85±0.64)cm,there were statistical differences(P<0.05).After treatment,the nutritional status indexes of serum albumin(ALB),transferrin(Tf),and total protein(TP)in the combined group were higher than those in the conventional group:(34.62±5.13)g/L vs.(31.75±4.93)g/L,(2.21±0.46)g/L vs.(2.00±0.42)g/L,(63.80±8.25)g/L vs.(60.24±6.97)g/L,there were statistical differences(P<0.05).After treatment,the percentage of forced expiratory volume in the first second(FEV_(1))to the expected value(FEV_(1)%)and the ratio of FEV_(1) to forced vital capacity(FEV_(1)/FVC)in the combined group were higher than those in the conventional group:(60.17±6.30)%vs.(57.25±6.24)%,(61.30±7.04)%vs.(57.12±7.25)%,there were st

关 键 词：肺疾病 慢性阻塞性 体外膈肌起搏 重组人生长激素 对比研究 

分 类 号：R56[医药卫生—呼吸系统]