特布他林雾化吸入联合有创-无创序贯机械通气治疗重症哮喘合并呼吸衰竭患者的临床疗效

doi:10.3969/j.issn.1671-7171.2023.04.006

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摘要【目的】探讨特布他林雾化吸入联合有创-无创序贯机械通气(ENMV)治疗重症哮喘合并呼吸衰竭患者的临床效果。【方法】选取2019年1月至2022年1月本院呼吸内科收治的106例重症哮喘合并呼吸衰竭患者,按照随机数字表法分为观察组和对照组,每组53例,对照组采用ENMV治疗,观察组在对照组基础上加用特布他林雾化吸入治疗。比较两组患者临床疗效、重症监护室(ICU)住院天数、气管插管率、呼吸机相关肺炎(VAP)发生率及治疗前后肺功能指标、血气指标、炎症因子水平。【结果】观察组总有效率为88.68%,显著高于对照组的73.58%,差异具有统计学意义(P<0.05)。治疗后,观察组第1秒用力肺活量占预计值百分比(FEV1%)、第一秒用力呼气容积(FEV1)与用力肺活量(FVC)的比值(FEV1/FVC)、最大呼气峰流速(PEF)等肺功能指标显著高于治疗前,且高于对照组。治疗后,观察组动脉血氧分压(PaO₂)、血氧饱和度(SpO₂)显著高于治疗前,且高于对照组;动脉血二氧化碳分压(PaCO₂)水平显著低于治疗前,且低于对照组。治疗后,观察组患者肿瘤坏死因子(TNF-α)、白介素-17(IL-17)、白介素-18(IL-18)水平、C反应蛋白(CRP)等炎症因子水平显著低于治疗前,且低于对照组。观察组ICU住院天数显著少于对照组(P<0.05),气管插管率显著低于对照组(P<0.05);两组患者VAP发生率比较,差异无统计学意义(P>0.05)。【结论】特布他林雾化吸入联合ENMV治疗重症哮喘合并呼吸衰竭的临床疗效显著,可有效改善患者肺功能及血气指标,减轻炎症反应,值得临床推广应用。

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关键词 ：哮喘/并发症, 呼吸功能不全/并发症, 哮喘/治疗, 特普他林/药理学, 呼吸,人工

Abstract：【Objective】 To investigate the clinical effect of terbutaline aerosol inhalation combined with invasive-noninvasive sequential mechanical ventilation (ENMV) in the treatment of severe asthma with respiratory failure. 【Methods】 A total of 106 patients with severe asthma complicated with respiratory failure admitted to the Department of Respiratory Medicine of our hospital from January 2019 to January 2022 were selected and divided into the observation group and the control group according to the random number table method,with 53 cases in each group. The control group was treated with ENMV,and the observation group was treated with terbutaline aerosol inhalation on the basis of the control group. We compared the clinical efficacy,length of stay in intensive care unit (ICU),tracheal intubation rate,incidence of ventilator-associated pneumonia (VAP),as well as lung function indicators,blood gas indicators,and inflammatory factor levels before and after treatment between two groups of patients. 【Results】 The total effective rate of the observation group was 88.68%,significantly higher than the control group's 73.58%,with a statistically significant difference (P<0.05). After treatment,the percentage of forced vital capacity in the first second (FEV1%),the ratio of forced expiratory volume in the first second (FEV1) to forced vital capacity (FEV1/FVC),and the maximum expiratory peak flow rate (PEF) in the observation group were significantly higher than those before treatment,and higher than those in the control group. After treatment,the arterial partial pressure of oxygen (PaO₂) and oxygen saturation (SpO₂) in the observation group were significantly higher than those before treatment,and higher than those in the control group; The level of arterial blood partial pressure of carbon dioxide (PaCO₂) was significantly lower than that before treatment,and also lower than that of the control group. After treatment,the tumor necrosis factor (TNF-α),the levels of inflammatory factors such as interleukin-17 (IL-17),interleukin-18 (IL-18),and C-reactive protein (CRP) in the observation group were significantly lower than those before treatment,and even lower than those in the control group. The length of ICU hospitalization in the observation group was significantly shorter than that in the control group (P<0.05),and the tracheal intubation rate was significantly lower than that in the control group (P<0.05); There was no statistically significant difference in the incidence of VAP between the two groups of patients (P>0.05). 【Conclusion】 Terbutaline atomization inhalation combined with ENMV has a significant clinical effect in the treatment of severe asthma with respiratory failure,which can effectively improve the lung function and blood gas indicators of patients,reduce inflammatory reaction,and is worthy of clinical application.

Key words： Asthma/CO Respiratory Insufficiency/CO Asthma/TH Terbutaline/PD Respiration,Artificial

收稿日期: 2022-08-24

中图分类号:

R562.25

通讯作者: * E-mail:369737782@qq.com

引用本文:

谢波, 李宁. 特布他林雾化吸入联合有创-无创序贯机械通气治疗重症哮喘合并呼吸衰竭患者的临床疗效[J]. 医学临床研究, 2023, 40(4): 500-503.
XIE Bo, LI Ning. Clinical Efficacy of Terbutaline Aerosol Inhalation combined with Invasive-noninvasive Sequential Mechanical Ventilation in the Treatment of Severe Asthma Complicated with Respiratory Failure. JOURNAL OF CLINICAL RESEARCH, 2023, 40(4): 500-503.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.04.006 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I4/500

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