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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (02) : 188 -192. doi: 10.3877/cma.j.issn.1674-6902.2020.02.013

论著

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
李中祎1, 张治2,†(), 曹路3, 谭冲1   
  1. 1. 430080　武汉，武汉市第九医院重症医学科
    2. 430050　武汉，武汉市第五医院重症医学科
    3. 443003　宜昌，三峡大学呼吸疾病研究所，宜昌市中心人民医院呼吸与危重症医学科
  • 收稿日期:2019-11-24 出版日期:2020-04-25
  • 通信作者: 张治
  • 基金资助:
    湖北省卫计委面上项目(WJ2019114)

Clinical efficacy of N-acetylcysteine combined with non-invasive positive pressure ventilation on acute exacerbation of chronic obstructive pulmonary disease

Zhongyi Li1, Zhi Zhang2,†(), Lu Cao3, Chong Tan1   

  1. 1. Department of Critical Care Medicine, Wuhan Ninth Hospital, Wuhan 430080, Hubei Province, China
    2. Department of Critical Care Medicine, Wuhan Fifth Hospital, Wuhan 430050, Hubei Province, China
    3. Department of Respiratory and Critical Care Medicine, Institute of Respiratory Diseases, Three Gorges University, Yichang Central People's Hospital, Yichang 443003, Hubei Province, China
  • Received:2019-11-24 Published:2020-04-25
  • Corresponding author: Zhi Zhang
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引用本文：

李中祎, 张治, 曹路, 谭冲. 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(02): 188-192.

Zhongyi Li, Zhi Zhang, Lu Cao, Chong Tan. Clinical efficacy of N-acetylcysteine combined with non-invasive positive pressure ventilation on acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(02): 188-192.

目的

研究N-乙酰半胱氨酸(NAC)联合无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性发作期(AECOPD)疗效及对患者气道重塑的影响。

方法

选择2016年10月至2019年10月我院AECOPD患者94例，根据治疗方案不同分为观察组53例和对照组41例，均给予激素、抗生素和支气管扩张剂等常规治疗和NIPPV，观察组在此基础上加用NAC雾化吸入，两组疗程均为14 d，比较两组临床疗效及治疗前后患者肺功能、动脉血气、炎症因子和气道重塑指标变化。

结果

观察组和对照组有效率分别为92.45%和82.93%(P>0.05)，两组临床疗效差异无统计学意义(P>0.05)。治疗14 d，两组FEV1、FEV1%和FEV1/FVC明显升高(P<0.05)，且观察组FEV1、FEV1%和FEV1/FVC高于对照组；两组pH和SpO2明显升高(P<0.05)，PaCO2明显降低(P<0.05)，且观察组pH和SpO2高于对照组，PaCO2低于对照组；两组血清TGF-β1、MMP-2和TIMP-2水平明显降低(P<0.05)，且观察组血清TGF-β1、MMP-2和TIMP-2水平低于对照组；差异均有统计学意义(P<0.05)。观察组治疗前后T、WA及WA%均无明显变化(P>0.05)，对照组T、WA及WA%均明显升高(P<0.05)，且观察组T、WA及WA%低于对照组，差异有统计学意义(P<0.05)。

结论

NAC联合NIPPV治疗AECOPD具有良好效果，可有效改善患者肺功能和动脉血气指标，同时还可抑制气道重塑进程，对改善患者预后具有重要意义。

关键词: 肺疾病, 慢性阻塞性, 急性加重期, N-乙酰半胱氨酸, 无创正压通气, 气道重塑
Objective

To study the efficacy of N-acetylcysteine (NAC) combined with non-invasive positive pressure ventilation (NIPPV) on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its effects on the airway remodeling of such patients.

Methods

From October 2016 to October 2019, 94 patients with AECOPD in our hospital were divided into an observation group (n=53) and a control group (n=41) according to the different treatment regimens. All the patients were given the conventional treatment such as hormones, antibiotics and bronchodilators and NIPPV, and the observation group was additionally given NAC aerosol inhalation. And the two groups were treated for 14 d. The clinical efficacies and changes in lung function, arterial blood gas, inflammatory factors and airway remodeling before and after treatment were compared between the two groups.

Results

The effective rates in the observation group and the control group were 92.45% and 82.93%, respectively, with no significant difference in the clinical efficacy between the two groups (P>0.05). After 14 d of treatment, the forced expiratory volume in one second (FEV1), FEV1%, and FEV1/the forced vital capacity (FVC) in the two groups were significantly increased (P<0.05), and the FEV1, FEV1% and FEV1/FVC in the observation group were higher than those of the control group. The pH value and the pulse oxygen saturation (SpO2) were significantly increased in the two groups (P<0.05), while the partial pressure of carbon dioxide in artery (PaCO2) was decreased significantly in the two groups (P<0.05), and the pH and SpO2 in the observation group were higher than those of the control group while the PaCO2 in the observation group was lower than that of the control group. The levels of serum transforming growth factor (TGF-β1), MMP-2 and TIMP-2 were significantly reduced in the two groups (P<0.05), and the levels of serum TGF-β1, MMP-2 and TIMP-2 in the observation group were lower than those of the control group (P<0.05). There were no significant changes in T, WA and WA% in the observation group before and after treatment (P>0.05), however, the T, WA and WA% in the control group after treatment were significantly increased after treatment (P<0.05), and the T, WA, and WA% in the observation group were lower than those of the control group (P<0.05).

Conclusion

NAC combined with NIPPV has a good effect on AECOPD. It can effectively improve the lung function and the arterial blood gas indexes of the AECOPD patients, and can also inhibit the process of airway remodeling. Therefore, NAC combined with NIPPV is of great significance for improving the prognosis of AECOPD patients.

Key words: Chronic obstructive pulmonary disease, Acute exacerbation period, N-acetylcysteine, Non-invasive positive pressure ventilation, Airway remodeling
表1 两组治疗前后肺功能比较
分　组 例数 FEV1(L) FEV1%(%) FEV1/FVC(%)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 53 1.54±0.31 1.89±0.42a 57.92±9.08 67.85±8.23a 50.76±8.49 63.87±7.91a
对照组 41 1.48±0.27 1.65±0.36a 58.24±8.71 64.09±8.14a 52.18±8.62 60.25±8.34a
  t值   1.001 2.974 0.174 2.227 0.805 2.159
  P值   0.319 0.004 0.862 0.028 0.423 0.033
表2 两组治疗前后动脉血气指标比较
分　组 例数 pH SpO2(%) PaCO2(mmHg)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 53 7.18±0.25 7.35±0.12 84.03±9.58 93.27±2.96a 54.73±4.86 43.61±3.25a
对照组 41 7.16±0.23 7.32±0.14 82.91±9.72 91.04±3.15a 56.24±4.92 45.98±3.07a
  t值   0.404 1.115 0.563 3.537 1.497 3.634
  P值   0.687 0.268 0.575 0.001 0.138 0.001
表3 两组治疗前后炎症因子比较
分　组 例数 TGF-β1(ng/L) MMP-2(ng/L) TIMP-2(ng/L)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 53 846.39±97.25 504.63±82.71 7.92±1.36 4.07±0.89 2.71±0.65 1.69±0.43
对照组 41 850.12±94.86 592.48±86.04 8.13±1.42 5.24±1.28 2.63±0.62 2.08±0.47
  t值   0.188 5.046 0.732 5.145 0.611 4.197
  P值   0.851 <0.001 0.466 <0.001 0.543 <0.001
表4 两组治疗前后气道重塑指标比较
分　组 例数 T(mm) WA(mm2) WA%
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 53 1.02±0.13 1.09±0.15 10.24±0.97 10.82±1.39 62.47±8.14 64.03±8.71
对照组 41 1.04±0.16 1.28±0.17 10.35±1.06 12.78±1.53 63.25±7.96 68.42±9.38
  t值   0.665 5.745 0.525 6.500 0.470 2.351
  P值   0.508 <0.001 0.601 <0.001 0.630 0.021
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