长期无创正压通气治疗COPD对患者血清PCT、HPT和SAA水平的影响被引量：9

Effect of long-term noninvasive positive pressure ventilation on the level of serum PCT,HPT and SAA in patients with COPD

暂未订购

导出

摘要目的探讨长期无创正压通气治疗慢性阻塞性肺疾病(COPD)对患者血清降钙素原(PCT)、触珠蛋白(HPT)和淀粉样蛋白A(SAA)水平的影响。方法前瞻性选择2019年2月至2020年1月南京医科大学附属无锡第二人民医院诊治的COPD患者78例作为研究对象,根据随机信封抽签原则将其分为研究组与对照组,各39例。对照组给予传统有创机械通气治疗,观察组在对照组治疗的基础上给予长期无创正压通气治疗,治疗观察时间为7 d。治疗7 d后测定2组患者的肺功能[第1秒用力呼气容积占预计值的百分比(FEV1% pred)、第1秒用力肺活量/用力肺活量(FEV1/FVC)]。记录2组患者有创通气时间、总机械通气时间。治疗7 d后,采用酶联免疫法检测血清PCT、HPT、SAA水平。记录2组患者在治疗期间出现的重新插管与呼吸机相关肺炎发生情况。结果研究组治疗7 d后FEV1% pred与FEV1/FVC值为(89.72±5.77)%、(80.09±2.58)%,对照组治疗7 d后分别为(72.84±6.11)%、(72.10±3.11)%。研究组患者治疗7 d后的FEV1% pred与FEV1/FVC值高于对照组,差异有统计学意义(P<0.05)。研究组的有创通气时间、总机械通气时间分别为(112.87±18.73)、(161.09±13.28)h,均显著少于对照组[(172.94±16.20)、(188.77±20.00)h],差异有统计学意义(P<0.05)。研究组治疗7 d后PCT、HPT、SAA水平分别为(0.24±0.03)ng/mL、(2.54±0.13)g/L、(8.35±0.32)g/L。对照组治疗7 d后PCT、HPT、SAA水平分别为(0.67±0.10)ng/mL、(1.58±0.12)g/L、(16.00±1.11)g/L。研究组患者治疗7 d后的PCT、SAA水平低于对照组,HPT水平高于对照组,差异有统计学意义(P<0.05)。研究组的重新插管与呼吸机相关肺炎发生率为2.6%和5.1%,显著低于对照组的15.4%和23.1%,差异有统计学意义(P<0.05)。结论长期无创正压通气治疗COPD能抑制血清PCT、SAA的释放,促进HPT的释放,也能显著改善患者的肺功能,缩短患者的机械通气时间,减少重新插管与呼吸机相关肺炎发生率。 Objective To discuss the effects of long-term noninvasive positive pressure ventilation on the level of serum the procalcitonin(PCT),haptoglobin(HPT)and serum amyloid A(SAA)in patients with chronic obstructive pulmonary disease(COPD).Methods From February 2019 to January 2020,78 cases of patients with COPD diagnosed and treated in Wuxi No.2 People's Hospital were selected as the research object,and the patients were divided into study group and control group of 39 cases in each groups accorded to the principle of random envelope drawing.The control group were given traditional invasive mechanical ventilation treatment,and the observation group were given long-term non-invasive positive pressure ventilation treatment based on the treatment of the control group.The treatment observation times were 7 days.Pulmonary function[forced expiratory volume in the first second as a percentage of predicted value(FEV1% pred),forced vital capacity in the first second/forced vital capacity(FEV1/FVC)]was measured before and 7 days after treatment.The invasive ventilation time and total mechanical ventilation time of the two groups of patients were recorded.Serum PCT,HPT,SAA levels were detected by enzyme-linked immunosorbent assay.The occurrence of reintubation and ventilator-related pneumonia in the two groups of patients during treatment was recorded.Results The FEV1% pred and FEV1/FVC values of the study group were(89.72±5.77)%and(80.09±2.58)% after 7 days of treatment.The FEV1% pred and FEV1/FVC values of the control group were(72.84±6.11)% and(72.10±3.11)% after 7 days of treatment.The FEV1% pred and FEV1/FVC values of the research group were higher than the control group,the differences were statistically significant(P<0.05).The invasive ventilation time and total mechanical ventilation time in the study group were(112.87±18.73)h,(161.09±13.28)h,which were significantly less than those in the control group[(172.94±16.20)h,(188.77±20.00)h](P<0.05).The levels of PCT,HPT,and SAA in the study group after 7 days of treatment were(0.24±0.03)ng/mL,(2.54±0.13)g/L,and(8.35±0.32)g/L,respectively.The levels of PCT,HPT and SAA in the control group after 7 days of treatment were(0.67±0.10)ng/mL,(1.58±0.12)g/L,and(16.00±1.11)g/L,respectively.After 7 days of treatment,the levels of PCT and SAA in the study group were lower than those in the control group,and the HPT levels were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of reintubation and ventilator-associated pneumonia in the study group was 2.6% and 5.1%,which was significantly lower than that in the control group,15.4% and 23.1%(P<0.05).Conclusion Long-term noninvasive positive pressure ventilation treatment of COPD can inhibit the release of serum PCT and SAA,promote the release of HPT,and can also significantly improve the patient's lung function,shorten the patient's mechanical ventilation time,and reduce the incidence of reintubation and ventilator-associated pneumonia.

作者阎兴月屠苏万方 YAN Xing-yue;TU Su;WAN Fang(Department of Emergency,Wuxi No.2 People's Hospital,Nanjing Medical University,Wuxi Jiangsu 214000,China)

机构地区南京医科大学附属无锡第二人民医院急诊科

出处《临床和实验医学杂志》 2020年第22期2424-2427,共4页 Journal of Clinical and Experimental Medicine

基金江苏省基础研究计划(自然科学基金)-青年科学基金(编号:BK20180166) 南京医科大学科技发展基金(编号:NMUB2018245)。

关键词慢性阻塞性肺疾病无创正压通气降钙素原触珠蛋白淀粉样蛋白A Chronic obstructive pulmonary disease Noninvasive positive pressure ventilation Procalcitonin Haptoglobin Serum amyloid A

分类号 R563.9 [医药卫生—呼吸系统]