The Mechanism of Acetylcysteine Aerosol Inhalation Combined with Non-invasive Ventilator NIPSV Mode in the Treatment of AECOPD with Respiratory Failure by Regulating Immune Inflammatory Response
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摘要:
目的 探究乙酰半胱氨酸雾化吸入配合无创呼吸机压力支持通气（NIPSV）模式通过调节免疫炎症反应治疗慢性阻塞性肺疾病急性期（AECOPD）合并呼吸衰竭的机制。 方法 选取2020年2月至2022年12月于安徽省桐城市人民医院就诊的AECOPD合并呼吸衰竭患者共计80例，依据治疗方案不同分为实验组（n = 42）及对照组（n = 38），实验组采用无创呼吸机NIPSV模式联合乙酰半胱氨酸雾化吸入，对照组采用无创呼吸机NIPSV模式，对比2组治疗前后肺功能：包括第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、FEV1/FVC；血气指标：动脉血氧分压（PaO2）、动脉血二氧化碳（PaCO2）、血氧饱和度（SaO2）；血清指标：白介素-6 （IL-6）、淀粉样蛋白A（SAA）、 C 反应蛋白（CRP）、T淋巴细胞亚群（CD3+、CD4+、CD8+）水平，比较治疗期间不良反应发生率。 结果 治疗后实验组FEV1、FVC、FEV1/FVC水平均明显高于对照组及治疗前（P < 0.05）；治疗后实验组PaO2、PaCO2、SaO2水平高于对照组及治疗前（P < 0.05）；治疗后实验组IL-6、SAA、CRP水平低于对照组及治疗前（P < 0.05）；治疗后2组CD3+、CD4+水平均升高，实验组高于对照组，CD8+水平降低，实验组低于对照组（P < 0.05）；实验组不良反应发生率明显低于对照组（P < 0.05）。 结论 AECOPD合并呼吸衰竭患者无创呼吸机NIPSV模式联合乙酰半胱氨酸吸入通过调节免疫炎症反应治疗后，能有效减轻炎性反应，提高肺功能及免疫功能的同时改善患者的血气指标。 -
关键词:
- 慢性阻塞性肺疾病急性期 /
- 呼吸衰竭 /
- 无创呼吸机压力支持通气 /
- 乙酰半胱氨酸
Abstract:Objective To explore the mechanism of acetylcysteine aerosol inhalation combined with non-invasive ventilator pressure supported ventilation （NIPSV） in the treatment of acute stage of chronic obstructive pulmonary disease （AECOPD） complicated with respiratory failure by regulating the immune inflammatory response. Methods A total of 80 patients with AECOPD combined with respiratory failure who were treated in Tongcheng People's Hospital of Anhui Province from February 2020 to December 2022 were selected and divided into experimental group （n = 42） and control group （n = 38） according to different treatment plans. The experimental group was treated with NIPSV mode combined with acetyl cysteine atomization inhalation. The control group was treated with non-invasive ventilator NIPSV mode. The pulmonary function of the two groups before and after treatment was compared, including forced expiratory volume （FEV1）, forced vital capacity （FVC） and FEV1/FVC. Blood gas index: arterial partial pressure of oxygen （PaO2）, arterial carbon dioxide （PaCO2）, and blood oxygen saturation （SaO2）; Serum indicators: Interleukin-6 （IL-6）, amyloid A （SAA）, C-reactive protein （CRP）, T lymphocyte subsets （CD3+, CD4+, CD8+） levels, and the incidence of adverse reactions during treatment were compared. Results After treatment, the levels of FEV1, FVC and FEV1/FVC in experimental group were significantly higher than those in control group and before treatment （P < 0.05）. After treatment, PaO2, PaCO2 and SaO2 levels in the experimental group were higher than those in the control group and before treatment （P < 0.05）. The levels of IL-6, SAA and CRP in the experimental group after treatment were lower than those in the control group and before treatment （P < 0.05）. After treatment, the levels of CD3+ and CD4+ were increased in both groups, the experimental group was higher than the control group, the CD8+ level was lower in the experimental group than the control group （P < 0.05）. The incidence of adverse reactions in experimental group was significantly lower than that in control group （P < 0.05）. Conclusion AECOPD combined with non-invasive ventilator NIPSV and acetylcysteine inhalation can effectively reduce the inflammatory response, improve lung function and immune function, and improve blood gas indexes in patients with respiratory failure. -
表 1 2组患者基线资料（$ \bar x \pm s $）
Table 1. Baseline data of patients between the two groups（$ \bar x \pm s $）
组别 n 年龄（岁） 病程（a） 呼吸衰竭程度 Ⅰ Ⅱ 实验组 42 67.39±3.59 10.29±2.58 18 24 对照组 38 68.67±4.27 10.49±3.29 19 19 t/χ2 1.456 0.304 0.409 P 0.150 0.762 0.522 
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表 2 对比治疗前后2组肺功能指标（$ \bar x \pm s $）
Table 2. Comparison of pulmonary function indexes of the two groups before and after treatment（$ \bar x \pm s $）
组别 n FEV1（L） FVC（L） FEV1/FVC（%） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 实验组 42 0.70±0.19 1.59±0.32∆ 1.39±0.22 2.23±0.41∆ 50.35±3.69 71.30±5.39∆ 对照组 38 0.72±0.15 1.20±0.35∆ 1.38±0.25 1.86±0.43∆ 51.27±4.56 64.51±6.38∆ t 0.518 5.206 0.190 3.938 0.996 5.157 P 0.605 <0.001* 0.849 <0.001* 0.322 <0.001* *P < 0.05；与治疗前比较，∆P < 0.05。
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表 3 2组治疗前后血气指标（$ \bar x \pm s $）
Table 3. Blood gas indicators before and after treatment between the two groups（$ \bar x \pm s $）
组别 n PaO2（%） PaCO2（mmHg） SaO2（mmHg） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 实验组 42 66.67±3.49 86.29±6.05∆ 36.53±4.39 45.04±3.49∆ 85.61±6.59 95.21±6.56∆ 对照组 38 66.97±4.28 71.01±7.08∆ 36.69±4.18 39.67±4.58∆ 85.68±5.72 90.28±5.37∆ t 0.344 10.405 0.166 5.931 0.050 3.654 P 0.731 <0.001* 0.868 <0.001* 0.959 <0.001* *P < 0.05；与治疗前比较，∆P < 0.05。
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表 4 2组治疗前后血清指标（$ \bar x \pm s $）
Table 4. Serum indicators before and after treatment between the two groups （$ \bar x \pm s $）
组别 n IL-6（pg/mL） SAA（pg/mL） CRP（mg/L） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 实验组 42 31.59±4.23 8.19±1.56∆ 156.37±15.49 32.49±4.69∆ 13.59±2.49 7.69±1.59∆* 对照组 38 30.86±5.63 15.49±2.46∆ 154.34±12.09 43.43±5.61∆ 14.59±3.27 9.86±1.63∆* t 0.659 16.005 0.648 9.493 1.547 6.023 P 0.511 <0.001* 0.518 <0.001* 0.125 <0.001* *P < 0.05；与治疗前比较，∆P < 0.05。
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表 5 对比2组治疗前后T淋巴细胞亚群（$ \bar x \pm s $）
Table 5. Comparison of T-lymphocyte subpopulations before and after treatment between the two groups
组别 n CD3+（%） CD4+（%） CD8+（%） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 实验组 42 52.43±4.89 63.49±4.19∆ 36.57±2.49 49.46±3.49∆ 36.57±3.41 28.49±2.46∆ 对照组 38 53.46±4.27 55.49±4.97∆ 37.43±3.27 37.49±4.58∆ 36.49±4.57 32.46±3.38∆ t 0.997 7.807 1.330 13.221 0.088 6.046 P 0.321 <0.001* 0.187 <0.001* 0.929 <0.001* *P < 0.05；与治疗前比较，∆P < 0.05。
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表 6 对比2组不良反应发生率[n（%）]
Table 6. Comparison of the incidence of adverse reactions between the two groups [n（%）]
组别 n 压疮 恶心 声音嘶哑 胸闷憋气 总发生 实验组 42 0（0.00） 1（2.38） 1（2.38） 1（2.38） 3（7.14） 对照组 38 3（7.89） 2（5.26） 2（5.26） 3（7.89） 10（26.31） χ2 5.388 P 0.020* *P < 0.05。
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[1] Wang S M,Zhang F Y,Du C L,et al. Epidemiology and issues of NIV-treated AECOPD patients with hypercapnic respiratory failure in Shanghai: A multicentre retrospective survey[J]. Clin Respir J,2021,15(5):550-557. doi: 10.1111/crj.13311 [2] Zhang J B,Zhu J Q,Cao L X,et al. Use of the modified glasgow coma scale score to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with AECOPD and respiratory failure[J]. Exp Ther Med,2020,20(2):1441-1446. doi: 10.3892/etm.2020.8884 [3] Feng Z, Zhang L, Yu H, et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for AECOPD patients after extubation: A systematic review and meta-analysis of randomized controlled trials[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17（1）: 1987-1999.Feng Z,Zhang L,Yu H,et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for AECOPD patients after extubation: A systematic review and meta-analysis of randomized controlled trials[J]. Int J Chron Obstruct Pulmon Dis,2022,17(1): 1987-1999. [4] McGinn K A,Weigartz K,Lintner A,et al. Nebulized heparin with N-acetylcysteine and albuterol reduces duration of mechanical ventilation in patients with inhalation injury[J]. J Pharm Pract.,2019,32(2):163-166. doi: 10.1177/0897190017747143 [5] 张弘,蔡柏蔷. 2017 ERS/ATS慢性阻塞性肺疾病急性加重管理指南解读[J]. 国际呼吸杂志,2017,37(9):641-646. doi: 10.3760/cma.j.issn.1673-436X.2017.09.001 [6] Cortegiani A,Longhini F,Madotto F,et al. High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: A multicenter non-inferiority randomized trial[J]. Crit Care,2020,24(1):692. doi: 10.1186/s13054-020-03409-0 [7] Gao E,Zhang C,Wang J. Effects of budesonide combined with noninvasive ventilation on PCT,sTREM-1,chest lung compliance,humoral immune function and quality of life in patients with AECOPD complicated with type II respiratory failure[J]. Open Med (Wars),2019,14(1):271-278. doi: 10.1515/med-2019-0023 [8] Zhang X,Yang P,Guo C,et al. Effects of volume-assured pressure support noninvasive ventilation in stable COPD with chronic respiratory failure: Meta-analysis and literature review[J]. Heart Lung,2020,49(3):287-295. doi: 10.1016/j.hrtlng.2020.01.007 [9] Ghazala L,Hatipoğlu U,Devnani T,et al. Duration of noninvasive ventilation is not a predictor of clinical outcomes in patients with acute exacerbation of COPD and respiratory failure[J]. Can J Respir Ther,2021,57(1):113-118. [10] Van Der Leest S,Duiverman ML. High-intensity non-invasive ventilation in stable hypercapnic COPD: Evidence of efficacy and practical advice[J]. Respirology,2019,24(4):318-328. doi: 10.1111/resp.13450 [11] 杨宝春,王丽东,孙欣. 乙酰半胱氨酸胶囊联合双水平无创正压通气治疗AECOPD合并Ⅱ型呼吸衰竭观察[J]. 中国药师,2020,23(3):485-487. doi: 10.3969/j.issn.1008-049X.2020.03.018 [12] 李春梅,胡莺,陈晓霞,等. 无创正压通气联合纤维支气管镜肺泡灌洗对老年AECOPD合并Ⅱ型呼吸衰竭患者肺功能及血气指标的影响[J]. 现代生物医学进展,2019,19(24):4752-4755. [13] 刘小珊,谢芳,郝小丹,等. 肠内-肠外联合营养与双水平气道正压通气对COPD急性加重期合并Ⅱ型呼吸衰竭患者的应用效果[J]. 贵州医科大学学报,2023,48(3):347-351,372. [14] Abubacker A P,Ndakotsu A,Chawla H V,et al. Non-invasive positive pressure ventilation for acute cardiogenic pulmonary edema and chronic obstructive pulmonary disease in prehospital and emergency settings[J]. Cureus,2021,13(6):e15624. [15] Sun J,Li Y,Ling B,et al. High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: An observational cohort study [published correction appears in Int J Chron Obstruct Pulmon[J]. Int J Chron Obstruct Pulmon Dis,2019,14(1):1229-1237. [16] 王宁,杨佳佳,王丹丹,等. 慢性阻塞性肺疾病急性加重合并呼吸机相关性肺炎患者病原菌分布及血清指标水平变化[J]. 实用医院临床杂志,2022,19(2):50-53. doi: 10.3969/j.issn.1672-6170.2022.02.014 [17] 裴蕾,李黎. 血清SP-D、SAA和CXCL12在AECOPD合并呼吸衰竭预后评估中的临床价值[J]. 检验医学与临床,2021,18(9):1270-1273,1277. doi: 10.3969/j.issn.1672-9455.2021.09.023 [18] 李中祎,张治,曹路,等. N-乙酰半胱氨酸联合无创正压通气治疗COPD急性发作的临床分析[J]. 中华肺部疾病杂志(电子版),2020,13(2):188-192. doi: 10.3877/cma.j.issn.1674-6902.2020.02.012 [19] 张媛媛,宫硕康,张新,等. 呼吸康复治疗联合乙酰半胱氨酸治疗COPD急性加重期的临床观察[J]. 川北医学院学报,2022,37(1):63-66. doi: 10.3969/j.issn.1005-3697.2022.01.015 [20] 李静,覃腊云,欧阳辉,等. 序贯肠内外营养支持对AECOPD合并呼吸衰竭患者营养指标、胃肠黏膜功能和免疫功能的影响[J]. 现代生物医学进展,2022,22(7):1333-1337. [21] 付伟,辛丽云,陈乾华. 乙酰半胱氨酸溶液雾化吸入对COPD患者免疫功能及肺功能的影响[J]. 实用药物与临床,2019,22(6):597-600. -
