布地格福吸入气雾剂联合无创正压通气对AECOPD并发Ⅱ型呼吸衰竭患者的临床分析

doi:10.3877/cma.j.issn.1674-6902.2025.05.021

目的

分析布地格福吸入气雾剂、无创正压通气(noninvasive positive pressure ventilation, NPPV)共同作用于慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)合并Ⅱ型呼吸衰竭的效果。

方法

纳入2021年1月至2024年1月我院收治AECOPD合并Ⅱ型呼吸衰竭患者102例，按照治疗方法不同分为对照组42例和观察组60例，对照组采取NPPV治疗，观察组在NPPV治疗基础上采取布地格福吸入气雾剂治疗。治疗时间2周，比较两组临床症状[圣乔治呼吸问卷(St George′s respiratory questionnaire, SGRQ)分值]、血气指标[动脉血氧分压(arterial partial pressure of oxygen, PaO₂)、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide, PaCO₂)]、炎症指标[C反应蛋白(C reactive protein, CRP)、及降钙素原(procalcitonin, PCT)]。及胸部CT右肺上叶尖段[气道壁厚度(airway wall thickness, WT)、气道壁厚度与气道外径比(airway wall thickness/airway diameter range, TDR)]。

结果

与治疗前比较及治疗后，两组SGRQ分值降低；两组血气参数得到改善，观察组低于对照组(P<0.05)；观察组PaO₂(80.56±9.47)mmHg、PaCO₂(45.47±4.89)mmHg优于对照组(73.11±8.52)mmHg、(51.34±5.63)mmHg(P<0.05)；两组炎症指标得到好转，观察组CRP(8.24±1.11)ng/ml、PCT(2.08±0.45)ng/ml低于对照组(12.60±2.63)ng/ml、(3.92±0.64)ng/ml(P<0.05)；观察组WT(1.42±0.03)mm，TDR(0.20±0.03)低于对照组WT(1.48±0.02)mm，TDR(0.24±0.02)(P<0.05)；观察组发生不良反应4例(6.67%)，对照组2例(4.76%)，两组比较差异无统计学意义(P>0.05)。

结论

AECOPD合并Ⅱ型呼吸衰竭采用布地格福、NPPV联合治疗，可减轻炎症反应，改善动脉血气指标，减轻临床症状及气道狭窄痉挛，具有意义。

关键词: 急性加重期，肺疾病，慢性阻塞性, Ⅱ型呼吸衰竭, 布地格福吸入气雾剂, 无创正压通气, 临床分析

Objective

To investigate the effect of budesonide inhalation aerosol and non-invasive positive pressure ventilation (NPPV) on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type Ⅱ respiratory failure.

Methods

A total of 102 patients with AECOPD complicated with type Ⅱ respiratory failure admitted to our hospital from January 2021 to January 2024 were enrolled. They were randomly divided into two groups, 42 cases in the control group and 60 cases in the observation group. The control group received NPPV treatment, while the observation group received additional budesonide inhalation aerosol treatment. After two weeks of treatment, the respiratory condition(SGRQ), arterial blood gas parameters, inflammatory markers and the airway wall thickness (WT), WT to airway diameter ratio (TDR) of the bronchial apical segment of the upper lobe of right lung were compared between the two groups.

Results

Compared with before treatment, after treatment, the SGRQ scores in the two groups decreased, the observation group was better than the control group (P<0.05); The blood gas analysis was improved, the observation group PaO₂(80.56±9.47) mmHg and PaCO₂(45.47±4.89)mmHg were better than the control group (73.11±8.52)mmHg and (51.34±5.63)mmHg (P<0.05); The inflammation indicators of the two groups were also improved. The CRP (8.24±1.11)ng/ml and PCT (2.08±0.45)ng/ml were lower than the control group (12.60±2.63)ng/ml and (3.92±0.64) ng/ml (P<0.05); The WT and TDR of the upper lobe apical segment of the right lung decreased compared with before treatment. The WT (1.42±0.03) mm in the observation group and the TDR (0.20±0.03) was lower than that of the WT (1.48±0.02) in the control group and the TDR (0.24±0.02) (P<0.05); There were 4 patients of adverse reactions in the observation group (6.67%) and 2 patients in the control group (4.76%), There was no significant difference between the two groups (P>0.05).

Conclusion

The combined treatment of budesonide and NPPV can improve respiratory condition, lung function, arterial blood gas parameters, and inflammatory response in patients with AECOPD complicated with type Ⅱ respiratory failure.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Type Ⅱ respiratory failure, Budesonide-formoterol inhalation aerosol, Non-invasive positive pressure ventilation, Respiratory function, Clinical analysis

表1 两组AECOPD患者治疗前后临床症状比较[分，(

±s)]

组　别	例数	疾病影响		呼吸症状		活动受限
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	60	54.57±2.20	33.33±2.04^a	56.78±1.56	31.37±1.88^a	67.28±1.91	39.35±1.95^a
对照组	42	54.69±1.94	40.64±2.13^a	56.93±1.55	40.14±2.00^a	67.52±1.69	47.45±1.73^a
t值		0.293	17.501	0.463	22.645	0.655	21.649
P值		0.770	0.001	0.644	0.001	0.514	0.001

表1 两组AECOPD患者治疗前后临床症状比较[分，(

±s)]

组　别	例数	疾病影响		呼吸症状		活动受限
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	60	54.57±2.20	33.33±2.04^a	56.78±1.56	31.37±1.88^a	67.28±1.91	39.35±1.95^a
对照组	42	54.69±1.94	40.64±2.13^a	56.93±1.55	40.14±2.00^a	67.52±1.69	47.45±1.73^a
t值		0.293	17.501	0.463	22.645	0.655	21.649
P值		0.770	0.001	0.644	0.001	0.514	0.001

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Clinical effect of budesonide inhalation aerosol combined with non-invasive positive pressure ventilation on patients with AECOPD complicated by type Ⅱ respiratory failure

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Clinical effect of budesonide inhalation aerosol combined with non-invasive positive pressure ventilation on patients with AECOPD complicated by type Ⅱ respiratory failure