比较布地格福吸入气雾剂分别联合经鼻氧疗(high-flow nasal cannula oxygen therapy, HFNC)与无创正压通气(non-invasive positive pressure ventilation, NIPPV)治疗慢性阻塞性肺疾病(chronic obstructive pulmonary diseases, COPD)并发Ⅱ型呼吸衰竭患者。

纳入我院收治的COPD并发Ⅱ型呼吸衰竭患者96例为对象，根据治疗方案不同，分为对照组45例与观察组51例，对照组给予布地格福吸入气雾剂联合NIPPV治疗，观察组给予布地格福吸入气雾剂联合HFNC治疗，两组连续治疗7~10 d。比较临床疗效，呼吸频率(respiratory rate, RR)、心率(heart rate, HR)、动脉血气分析参数：计算氧合指数(oxygenation index, PaO₂/FiO₂)、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide, PaCO₂)、动脉血氧分压(partial pressure of arterial oxygen, PaO₂)、pH，电子计算机断层肺扫描(computed tomography, CT)及肺功能指标[呼气峰流速(peak expiratory flow, PEF)、第1秒用力呼吸容积/用力肺活量(forced expiratory volume in one second/forced vital capacity, FEV₁/FVC)、最大吸气末容积(maximal inspiratory volume, MIV)、最大呼气末容积(maximal expiratory volume, MEV)]，氧化应激与炎症指标[β₂-微球蛋白(β₂-microglobulin, β₂-MG)、胆碱酯酶(cholinesterase, CHE)、可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1, sICAM-1)、脂质过氧化物(lipid peroxidation, LPO)]，呼吸情况、治疗舒适度及不良反应[COPD评估测试(COPD assessment test, CAT)、Kolcaba舒适状况量表(general comfort questionnaire, GCQ)评分、改良呼吸困难指数评分(modified medical research council, mMRC)]。

观察组肺功能改善45例(88.24%)高于对照组34例(75.56%)(P<0.05)；观察组RR(18.43±1.85)次/min、HR(82.89±3.24)次/min、PaCO₂(49.83±3.14)mmHg、LPO(4.56±1.31)nmol/L、sICAM-1(185.45±19.77)ng/ml、β2-MG水平(2.19±0.48)mg/L、MIV(4 287.51±314.27)、MEV(2 123.06±274.33)及CAT(13.74±2.18)分、mMRC评分(1.57±0.33)分低于对照组(19.54±2.02)次/min、(84.57±3.36)次/min、(51.35±3.43)mmHg、(5.35±1.47)nmol/L、(196.52±22.37)ng/ml、(2.19±0.48)mg/L、(4 431.24±329.45)、(2 269.62±285.47)、(15.13±2.32)分、(1.76±0.38)分(P<0.05)；观察组PaO₂/FiO₂(304.54±22.71)mmHg、PaO₂(66.11±3.56)mmHg、PEF(356.42±25.68)L/min、pH(7.37±0.08)、FEV₁/FVC值(70.07±5.22)%、CHE(3876.29±455.38)U/L、GCQ评分(85.07±4.12)高于对照组的(292.36±24.42)mmHg、(64.25±3.43)mmHg、(343.26±24.73)L/min、(7.33±0.09)、(67.76±4.84)%、(3 658.17±423.35)U/L、(82.75±4.34)分(P<0.05)。

布地格福联合HFNC对COPD伴Ⅱ型呼吸衰竭有疗效，可降低患者体内氧化应激与炎症反应，改善生理、呼吸功能、通气状况及舒适度具有意义。

To compare the effects of budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with high-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NIPPV) respectively in the treatment of patients with chronic obstructive pulmonary diseases (COPD) complicated with type Ⅱ respiratory failure.

A total of 96 patients with COPD complicated with type Ⅱ respiratory failure admitted to our hospital were collected as the research objects. They were divided into a control group with 45 cases and an observation group with 51 cases. The control group was treated with budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with NIPPV, and the observation group was treated with budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with HFNC. Both groups were continuously treated for 7 to 10 days. The clinical efficacy, arterial blood gas analysis [respiratory rate (RR), heart rate (HR), oxygenation index (PaO₂/FiO₂), arterial partial pressure of carbon dioxide (PaCO₂), partial pressure of arterial oxygen (PaO₂), potential of hydrogen (pH)], computed tomography (CT) of the lungs and pulmonary function indexes [peak expiratory flow (PEF), forced expiratory volume in one second/forced vital capacity (FEV₁/FVC), maximal inspiratory volume (MIV), maximal expiratory volume (MEV)], oxidative stress and inflammatory indexes [β₂-microglobulin (β₂-MG), cholinesterase (CHE), soluble intercellular adhesion molecule-1 (sICAM-1), lipid peroxidation (LPO)], respiratory status, treatment comfort level and adverse reactions [COPD assessment test (CAT), Kolcaba general comfort questionnaire (GCQ) score, modified medical research council (mMRC) score] were compared between the two groups.

In the observation group, 32 cases were effective and 15 cases were improved, and the improvement rate of pulmonary function was 45 cases(88.24%), which was higher than that in the control group (24 cases were effective and 11 cases were improved, and the improvement rate of pulmonary function was 34 cases(75.56%). The levels of RR, HR, PaCO₂, LPO, sICAM-1, β₂-MG, MIV, MEV, CAT and mMRC scores in the observation group were (18.43±1.85) times/min, (82.89±3.24) times/min, (49.83±3.14) mmHg, (4.56±1.31) nmol/L, (185.45±19.77) ng/ml, (2.19±0.48) mg/L, (4287.51±314.27), (2123.06±274.33), (13.74±2.18) points and (1.57±0.33) points respectively, which were lower than those in the control group [(19.54±2.02) times/min, (84.57±3.36) times/min, (51.35±3.43) mmHg, (5.35±1.47) nmol/L, (196.52±22.37) ng/ml, (2.19±0.48) mg/L, (4 431.24±329.45), (2 269.62±285.47), (15.13±2.32) points and (1.76±0.38) points] (P<0.05). The levels of PaO₂/FiO₂, PaO₂, PEF, pH, FEV₁/FVC value, CHE level and GCQ score in the observation group were (304.54±22.71) mmHg, (66.11±3.56) mmHg, (356.42±25.68) L/min, (7.37±0.08), (70.07±5.22)%, (3 876.29±455.38) U/L and (85.07±4.12) points respectively, which were higher than those in the control group (292.36±24.42) mmHg, (64.25±3.43) mmHg, (343.26±24.73) L/min, (7.33±0.09), (67.76±4.84)%, (3 658.17±423.35) U/L and (82.75±4.34) points (P<0.05).

Budesonide, glycopyrronium bromide and formoterol fumarate combined with HFNC has an obvious curative effect on COPD patients with type Ⅱ respiratory failure, which can reduce the oxidative stress and inflammatory reaction in patients, and improve their physiological function, respiratory function, ventilation status and comfort level.