稳定期慢性阻塞性肺疾病合并呼吸衰竭患者应用无创正压通气联合吸入糖皮质激素的临床效果及对血清基质金属蛋白酶9的影响
은정기만성조새성폐질병합병호흡쇠갈환자응용무창정압통기연합흡입당피질격소적림상효과급대혈청기질금속단백매9적영향
Efficacy and impact on serum matrix metalloproteinase-9 of long-term non-invasive positive pressure ventilation combined with inhaling corticosteroids in patients with stable severe chronic obstructive pulmonary disease complicated with respiratory failur
  • 万方数据
    中国综合临床 중국종합림상
    CLINICAL MEDICINE OF CHINA
    2013年 8期 824-828 ,共5页

    于立萍%巩法桃%王新安%李燕燕%邢海燕%张颖%欧阳修河

    우립평%공법도%왕신안%리연연%형해연%장영%구양수하

    慢性阻塞性肺疾病%呼吸衰竭%无创正压通气%糖皮质激素%基质金属蛋白酶9 慢性阻塞性肺疾病%呼吸衰竭%無創正壓通氣%糖皮質激素%基質金屬蛋白酶9
    만성조새성폐질병%호흡쇠갈%무창정압통기%당피질격소%기질금속단백매9
    Chronic obstructive pulmonary disease%Respiratory failure%Non-invasive positive pressure ventilation%Corticosteroids%Matrix metalloproteinase-9
    目的 观察长期无创正压通气(NIPPV)联合吸入糖皮质激素对稳定期慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者临床疗效及血清基质金属蛋白酶9(MMP-9)的影响.方法 选择80例处于稳定期的严重COPD合并呼吸衰竭患者,按其治疗方法分为实验组和对照组,两组患者均给予吸氧、吸入沙美特罗替卡松粉吸入剂等治疗,实验组在此基础上联合双水平无创正压通气治疗1年.观察两组患者治疗前、后圣乔治问卷评分(SGRQ评分)、呼吸困难评分(MMRC评分)、6min行走距离(6-MWT)、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、1秒钟用力呼气容积占预计值的百分比(FEV1％)及血清MMP-9等变化,并记录两组患者治疗前及治疗后1年内急性发作及住院情况.结果 治疗前、后实验组SGRQ评分、MMRC评分、6-MWT、PaO2、PaCO2、FEV1％、血清MMP-9分别是(63.38±4.46)分与(52.93±4.30)分(t=10.67,P.=0.00)、(3.60±0.50)分与(2.40±0.50)分(t=10.82,P=0.00)、(159.90±6.50)m与(247.10±9.66) m(t =47.39,P =0.00)、(56.85±1.67) mmHg与(66.10±2.59)mm Hg(t=10.67,P=0.00)、(60.38±3.58) mm Hg与(51.88±3.05) mm Hg(t=10.82,P =0.00)、(38.93±3.22)％与(42.12±3.11)％(t =47.39,P=0.00)、(182.58±6.60) μg/L与(171.73±6.19)μg/L(t =7.58,P=0.00),治疗前、后对照组SGRQ评分、MMRC评分、6-MWT、PaO2、PaCO2 、FEV1％、血清MMP-9分别是(63.88±4.88)分与(54.30±4.13)分(t=8.77,P=0.00)、(3.65±0.48)分与(2.70±0.46)分(t=8.97,P =0.00)、(157.98±5.97)m与(218.08±13.12) m(t =26.38,P =0.00)、(56.65±1.51) mm Hg与(62.60±1.91) mm Hg(t=8.77,P=0.00)、(60.20±3.52) mm Hg与(56.25±3.09)mm Hg(t=8.97,P =0.00)、(38.93 ±2.96)％与(40.70±3.27)％(￡=26.38,P=0.00)、(180.55±4.78) μg/L与(173.05±5.28)ug/L(t=6.66,P=0.00),实验组改善优于对照组(P值分别为0.03、0.02、0.00、0.00、0.00、0.00、0.00)；急性发作次数、住院天数等明显减少,实验组优于对照组.结论 严重COPD合并呼吸衰竭患者稳定期长期无创正压通气联合糖皮质激素吸入治疗可明显提高患者生活质量,降低血清MMP-9水平.
    목적 관찰장기무창정압통기(NIPPV)연합흡입당피질격소대은정기만성조새성폐질병(COPD)합병호흡쇠갈환자림상료효급혈청기질금속단백매9(MMP-9)적영향.방법 선택80례처우은정기적엄중COPD합병호흡쇠갈환자,안기치료방법분위실험조화대조조,량조환자균급여흡양、흡입사미특라체잡송분흡입제등치료,실험조재차기출상연합쌍수평무창정압통기치료1년.관찰량조환자치료전、후골교치문권평분(SGRQ평분)、호흡곤난평분(MMRC평분)、6min행주거리(6-MWT)、동맥혈양분압(PaO2)、이양화탄분압(PaCO2)、1초종용력호기용적점예계치적백분비(FEV1％)급혈청MMP-9등변화,병기록량조환자치료전급치료후1년내급성발작급주원정황.결과 치료전、후실험조SGRQ평분、MMRC평분、6-MWT、PaO2、PaCO2、FEV1％、혈청MMP-9분별시(63.38±4.46)분여(52.93±4.30)분(t=10.67,P.=0.00)、(3.60±0.50)분여(2.40±0.50)분(t=10.82,P=0.00)、(159.90±6.50)m여(247.10±9.66) m(t =47.39,P =0.00)、(56.85±1.67) mmHg여(66.10±2.59)mm Hg(t=10.67,P=0.00)、(60.38±3.58) mm Hg여(51.88±3.05) mm Hg(t=10.82,P =0.00)、(38.93±3.22)％여(42.12±3.11)％(t =47.39,P=0.00)、(182.58±6.60) μg/L여(171.73±6.19)μg/L(t =7.58,P=0.00),치료전、후대조조SGRQ평분、MMRC평분、6-MWT、PaO2、PaCO2 、FEV1％、혈청MMP-9분별시(63.88±4.88)분여(54.30±4.13)분(t=8.77,P=0.00)、(3.65±0.48)분여(2.70±0.46)분(t=8.97,P =0.00)、(157.98±5.97)m여(218.08±13.12) m(t =26.38,P =0.00)、(56.65±1.51) mm Hg여(62.60±1.91) mm Hg(t=8.77,P=0.00)、(60.20±3.52) mm Hg여(56.25±3.09)mm Hg(t=8.97,P =0.00)、(38.93 ±2.96)％여(40.70±3.27)％(￡=26.38,P=0.00)、(180.55±4.78) μg/L여(173.05±5.28)ug/L(t=6.66,P=0.00),실험조개선우우대조조(P치분별위0.03、0.02、0.00、0.00、0.00、0.00、0.00)；급성발작차수、주원천수등명현감소,실험조우우대조조.결론 엄중COPD합병호흡쇠갈환자은정기장기무창정압통기연합당피질격소흡입치료가명현제고환자생활질량,강저혈청MMP-9수평.
    Objective To investigate the clinical efficacy of the treatment of long-term non-invasive positive pressure ventilation (NIPPV) combined with inhaling corticosteroids in patients with stable chronic o0bstructive pulmonary disease(COPD) complicated with respiratory failure,and to investigate the impact of longterm NIPPV combined with inhaling corticosteroids on serum levels of matrix metalloproteinase-9 (MMP-9).Methods Eighty outpatients of stable severe COPD complicated with respiratory failure divided them equally into two treatment groups (the experimental and the control groups).The two groups of patients were given oxygen therapy,inhalation of Salmeterol and fluticasone propionate powder for one year.The experimental group received additionally NIPPV therapy for 1 year.The outcomes measured included St.George's questionnaire (SGRQ) score,MMRC score,6-min working time (6-MWT),arterial partial pressure of oxygen (PaO2),partial pressure of carbon dioxide(PaCO2),Forced expiratory volume in 1 (FEV1％),and the serum levels of MMP-9 before and after treatment,and frequency of acute exacerbations of COPD and hospital says in the last one year and the following 12 months.Results After 1 year,the differences of SGRQ score,MMRC score,6-MWT,PaO2,PaCO2,FEV1％,MMP-9 in the experimental group ((63.38 ±4.46) vs.(52.93 ±4.30),t =10.67,P =0.00;(3.60±0.50) vs.(2.40 ±0.50),t =10.82,P=0.00;(159.90 ±6.50) m vs.(247.10±9.66) m,t=47.39,P=0.00;(56.85 ± 1.67) mm Hg vs.(66.10 ±2.59) mm Hg,t =10.67,P =0.00;(60.38 ±3.58)mm Hgvs.(51.88 ±3.05)mm Hg,t=10.82,P=0.00; (38.93 ±3.22)％ vs.(42.12 ±3.11)％,t=47.39,P =0.00;(182.58 ±6.60) μg/L vs.(171.73 ±6.19) μg/L,t =7.58,P =0.00) were statistically significant compared to the control group ((63.88 ± 4.88) vs.(54.30 ± 4.13),t =8.77,P =0.00; (3.65 ± 0.48) vs.(2.70±0.46),t =8.97,P =0.00;(157.98 ±5.97) m vs.(218.08±13.12) m,t =26.38,P=0.00;(56.65 ±1.51)mm Hg vs.(62.60 ± 1.91)mm Hg,t=8.77,P=0.00; (60.20 ±3.52)mm Hg vs.(56.25 ±3.09)mm Hg,t =8.97,P =0.00; (38.93 ±2.96) ％ vs.(40.70 ±3.27)％,t =26.38,P =0.00; (180.55 ±4.78) μg/L vs.(173.05 ± 5.28) μg/L,t =6.66,P =0.00).The frequency of acute exacerbations of COPD and hospital stay days were significantly decreased in the experimental group than in the control group.Conclusion Long-term NIPPV combined with inhaling corticosteroids could significantly improve the quality of life and lower the serum levels of MMP-9 of patients with severe stable COPD complicated with respiratory failure.
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