多沙普仑联合无创正压通气治疗慢性阻塞性肺疾病急性加重期并发呼吸衰竭的临床意义
Clinical significance of doxapram combined with noninvasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure

刘迪丹.多沙普仑联合无创正压通气治疗慢性阻塞性肺疾病急性加重期并发呼吸衰竭的临床意义[J].内科急危重症杂志,2019,25(4):313-316

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DOI：10.11768/nkjwzzzz20190415

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作者	单位	E-mail
刘迪丹	广东省汕头市潮阳区大峰医院	liudidan2010@163.com

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中文摘要:

目的：探讨多沙普仑联合无创正压通气对慢性阻塞性肺疾病急性加重期（AECOPD）并发呼吸衰竭患者外周血中Th1/Th2、TREM-1的影响。方法：选择AECOPD伴呼吸衰竭患者80例，按照随机数字表法分为对照组和观察组，每组40例。对照组采用无创正压通气治疗，观察组予多沙普仑联合无创正压通气治疗。比较2组患者治疗前及治疗24h后血气指标，检测治疗前和治疗结束后呼吸频率、潮气量和分钟通气量、血IL-2、IL-4、Th1/Th2及TREM-1水平，观察2组患者治疗期间不良反应发生情况。结果：治疗前2组患者的血气指标、呼吸频率、潮气量和分钟通气量、血IL-2、IL-4、Th1/Th2及TREM-1水平比较, 差异无统计学意义（均P>0.05），治疗后以上指标均得到不同程度的改善（均P<0.05），其中观察组的PaO2显著高于对照组，PaCO2显著低于对照组，呼吸频率和分钟通气量显著高于对照组（均P<0.05）。观察组的有创通气率及死亡率显著低于对照组（P<0.05）。治疗后观察组的IL-2、Th1/Th2水平显著高于对照组，IL-4、TREM-1水平显著低于对照组（P<0.05）。2组不良反应发生情况比较, 差异无统计学意义（P>0.05）。结论：多沙普仑联合无创正压通气治疗可改善AECOPD患者的血气指标，提高通气量，并具有一定安全性。

英文摘要:

Objective: To investigate the effect of doxapram combined with noninvasive positive pressure ventilation on peripheral blood Th1/Th2 and triggering receptor expressed on myeloid cells-1 (TREM-1) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients complicated with respiratory failure. Methods: A total of 80 patients with AECOPD accompanied by respiratory failure were selected. The patients were divided into control group and observation group according to the digital random table method, 40 cases in each group. The control group was treated with noninvasive positive pressure ventilation, and the observation group was given doxapram combined with non-invasive positive pressure ventilation. The blood gas indexes before and 24 h after treatment was compared between the two groups. The respiratory rate, tidal volume and minute ventilation, Th1/Th2 levels and TREM-1 levels before and after treatment were compared between the two groups. Adverse reactions were observed in two groups. Results: There were no significant differences in blood gas indexes, respiratory rate, tidal volume and minute ventilation between the two groups before treatment (P>0.05). After treatment, the above mentioned indicators were improved to varying degrees (P<0.05). The PaO2 was significantly higher, PaCO2 was significantly lower, and respiratory rate and minute ventilation were significantly higher in the observation group than those in the control group (all P<0.05). The invasive ventilation rate and mortality in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of IL-2 and Th1/Th2 were significantly higher, and those of IL-4 and TREM-1 were significantly lower in the observation group than those in the control group (all P<0.05). There was no significant difference in adverse reactions between the two groups (P>0.05). Conclusion: Doxapram combined with non-invasive positive pressure ventilation can improve blood gas indexes, increase ventilation, and is safe to some extent.