摘要
目的:分析纤维支气管镜联合氨溴索在慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)伴呼吸衰竭中疗效及其对血气指标、肺功能和血乳酸水平的影响。方法:将2019年1月至2022年1月我院收治的154例COPD伴呼吸衰竭患者作为对象，采用单双球法随机分为对照组77例和观察组77例。对照组给予常规治疗联合氨溴索，观察组给予纤维支气管镜联合氨溴索治疗。观察两组患者治疗2周后疗效[改良版英国医学研究委员会呼吸困难量表(mMRC)、慢性阻塞性肺病评估测试(CAT)]、血气指标[血氧饱和度(SaO2)、氧分压(PaO2)、二氧化碳分压(PaCO2)]、肺功能指标[最大呼气流量(PEF)、第1秒用力呼气量占预计值百分比(FEV1/FVC%)、二氧化碳生成量(VCO2)、氧耗量(VO2)]、胸肺顺应性指标[肺顺应性(Cl)、总顺应性(Ct)、胸廓顺应性(Cth)]、炎症因子[降钙素原(PCT)、C反应蛋白(CRP)]和动脉血乳酸水平。结果:治疗2周后，两组患者疗效(mMRC、CAT)评分、PaCO2、部分肺功能指标(VCO2、VO2)、部分炎症因子指标(PCT、CRP)及动脉血乳酸水平较治疗前降低，观察组低于对照组(P<0.05)；部分血气指标(SaO2、PaO2)、FEV1/FVC%、胸肺顺应性指标(Cl、Ct、Cth)水平较治疗前升高，观察组高于对照组(P<0.05)。结论:将纤维支气管镜与氨溴索联合可提高COPD伴呼吸衰竭患者临床效果，改善患者血气水平及肺功能，有效降低炎症因子及动脉血乳酸水平。
Abstract
Objective:To explore the efficacy of fiberoptic bronchoscopy combined with ambroxol in treating chronic obstructive pulmonary disease (COPD) with respiratory failure and its effects on blood gas indicators, pulmonary function and level of blood lactate.Methods:154 patients with COPD and respiratory failure who were treated in the hospital between January 2019 and January 2022 were selected as the research subjects, and they were randomly divided into control group (n=77) and observation group (n=77) by the single-double ball method. The control group was given routine treatment combined with ambroxol while the observation group was given fiberoptic bronchoscopy combined with ambroxol. The efficacy [modified British Medical Research Council dyspnea scale (mMRC), Chronic Obstructive Pulmonary Disease Assessment Test (CAT)], blood gas indicators [blood oxygen saturation (SaO2), partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2)], pulmonary function indicators [peak expiratory flow (PEF), percentage of forced expiratory volume in 1 second to predicted value (FEV1/FVC%), carbon dioxide production (VCO2), oxygen consumption (VO2)], thoracic and lung compliance indicators [lung compliance (Cl), total compliance (Ct), thoracic compliance (Cth)], inflammatory factors [procalcitonin (PCT), C-reactive protein (CRP)] and arterial blood lactate were observed in the two groups of patients after 2 weeks of treatment.Results:After 2 weeks of treatment, the efficacy (mMRC score, CAT score), PaCO2, partial pulmonary function indicators(VCO2, VO2), partial inflammatory factors (PCT, CRP) and arterial blood lactate in the two groups were reduced compared with those before treatment, and the above indicators in observation group were lower than those in control group (all P<0.05). The levels of partial blood gas indicators (SaO2, PaO2), FEV1/FVC%, chest and lung compliance indicators (Cl, Ct, Cth) were enhanced compared with those before treatment, and the levels in observation group were higher than those in control group (all P<0.05).Conclusion:Combining fiberoptic bronchoscopy with ambroxol can enhance the clinical efficacy, improve the blood gas level and pulmonary function, and effectively reduce the levels of inflammatory factors and arterial blood lactate of patients with COPD complicated with respiratory failure.
万方数据