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

doi:10.3877/cma.j.issn.1674-6902.2020.02.013

Abstract

Abstract:

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

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.

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Figures/Tables 4

References 25

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分　组		例数	FEV₁(L)		FEV₁%(%)		FEV₁/FVC(%)
分　组		例数	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±0.42^a	57.92±9.08	67.85±8.23^a	50.76±8.49	63.87±7.91^a
对照组		41	1.48±0.27	1.65±0.36^a	58.24±8.71	64.09±8.14^a	52.18±8.62	60.25±8.34^a
	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

分　组		例数	FEV₁(L)		FEV₁%(%)		FEV₁/FVC(%)
分　组		例数	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±0.42^a	57.92±9.08	67.85±8.23^a	50.76±8.49	63.87±7.91^a
对照组		41	1.48±0.27	1.65±0.36^a	58.24±8.71	64.09±8.14^a	52.18±8.62	60.25±8.34^a
	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

分　组		例数	pH		SpO₂(%)		PaCO₂(mmHg)
分　组		例数	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±2.96^a	54.73±4.86	43.61±3.25^a
对照组		41	7.16±0.23	7.32±0.14	82.91±9.72	91.04±3.15^a	56.24±4.92	45.98±3.07^a
	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

分　组		例数	pH		SpO₂(%)		PaCO₂(mmHg)
分　组		例数	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±2.96^a	54.73±4.86	43.61±3.25^a
对照组		41	7.16±0.23	7.32±0.14	82.91±9.72	91.04±3.15^a	56.24±4.92	45.98±3.07^a
	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

分　组		例数	TGF-β1(ng/L)		MMP-2(ng/L)		TIMP-2(ng/L)
分　组		例数	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

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