氨茶碱及高压氧治疗老年呼吸衰竭疗效及对患者肺功能影响_谭小田.pdf

现代生物医学进展Progress in Modern Biomedicine Vol.23NO.1JAN.2023doi:10.13241/ki.pmb.2023.01.016氨茶碱及高压氧治疗老年呼吸衰竭疗效及对患者肺功能影响*谭小田1姜文瑞2宋立强2李源3苏慧3谢柏梅1（1 空军第九八六医院干部病房（老年科）陕西 西安 710054；2 空军军医大学第一附属医院呼吸内科 陕西 西安 710032；3 空军军医大学第一附属医院老年科 陕西 西安 710032）摘要 目的：探讨氨茶碱及高压氧治疗老年呼吸衰竭疗效及对患者肺功能影响。方法：采取回顾性研究法，选择 2016 年 8 月到2021 年 5 月在本院诊治的老年呼吸衰竭患者 84 例作为研究对象，以随机 1:1 数字表法方式把患者平均分为对照组和联合组各42 例。两组都给予无创机械通气治疗，对照组给予雾化吸入氨茶碱治疗，联合组在对照组治疗的基础上给予高压氧治疗，两组都治疗观察 14 d。结果：两组治疗后的动脉血氧分压（PaO2）值显著升高，动脉二氧化碳分压（PaCO2）值显著降低，对比存在明显差异，治疗后联合组的 PaCO2、PaO2值与对照组对比存在明显差异（P0.05）。治疗后，联合组总有效率为 97.6%，高于对照组 83.3%（P0.05）。治疗后，联合组与对照组的一秒用力呼气容积（FEV1）/用力肺活量（FVC）值都明显高于治疗前，联合组明显高于对照组（P0.05）。治疗后联合组与对照组的血清白细胞介素（IL）-6、IL-10 水平都呈现明显下降趋势，且联合组明显低于对照组（P0.05）。结论：氨茶碱联合高压氧治疗老年呼吸衰竭能抑制 IL-6、IL-10 的表达，改善机体的血气状况与肺功能，提高总体治疗效果，减少并发症的发生，值得在临床上推广使用。关键词：氨茶碱；高压氧；老年人；呼吸衰竭中图分类号：R563.8文献标识码：A文章编号：1673-6273（2023）01-82-05Efficacy of Aminophylline and Hyperbaric Oxygen in the Treatment of SenileRespiratory Failure and Their Effects on Pulmonary Function*TAN Xiao-tian1,JIANG Wen-rui2,SONG Li-qiang2,LI Yuan3,SU Hui3,XIE Bai-mei1(1 Cadres Ward(Department of geriatrics),986 Hospital of Air Force,Xian,Shaanxi,710054,China;2DepartmentofRespiratorymedicine,TheFirstAffiliatedHospitalofAirForceMilitaryMedicalUniversity,Xian,Shaanxi,710032,China;3 Department of geriatrics,The First Affiliated Hospital of Air Force Military Medical University,Xian,Shaanxi,710032,China)ABSTRACT Objective:To investigate the efficacy of aminophylline and hyperbaric oxygen in the treatment of elderly patients withrespiratory failure and their effects on pulmonary function.Methods:Used a retrospective study method,from August 2016 to May 2021,84 caes of elderly patients with respiratory failure who were diagnosed and treated in our hospital were selected as the research objects,and the patients were equally divided into the control group and the combination group by random 1:1 digital table method.Both groupswere treated with non-invasive mechanical ventilation,the control group were treated with nebulized aminophylline,and the combinationgroup were treated with hyperbaric oxygen on the basis ofthe treatment ofthe control group.Both groups were treated for 14 days.Results:After treatment,the PaO2values of the two groups were significantly increased,and the PaCO2values were decreased,and there were dif-ference compared between the two groups(P0.05).The total effective rates after treatment in the combination group were 97.6%,whichwere significantly higher than 83.3%in the control group(P0.05).After treatment,the FEV1/FVC values of the combination group andthe control group were significantly higher than those before treatment(P0.05),and the combination group were higher than that beforetreatment,and were higher than the control group(P0.05).After treatment,the serum interleukin(IL)-6 and IL-10 levels in the combina-tion group and the control group were showed significant downward trend,and the combination group were lower than the control group(P0.05）。详见表 1。经本院伦理委员会批准者。表 1 两组一般资料对比Table 1 Comparison of the two groups of general dataGroupsnSystolic bloodpressure(mmHg)Diastolic bloodpressure(mmHg)Heart rate(secondary/min)Age(year)Admission bodytemperature()Gender(male/female)Joint group42126.2210.4876.878.1492.171.5865.924.9238.990.7822/20Matched group42126.989.8976.278.2192.542.1665.225.1938.290.9921/211.2 治疗方法两组都给予无创机械通气治疗，选择合适尺寸的鼻/面罩，连接美国飞利浦伟康公司的双水平无创呼吸机 ST 型呼吸机，使用双水平气道正压通气模式。通气参数：呼气压力 4-8 cmH2O，吸气压力 16-20 cm H2O，面罩旁供氧 5-10 L/min。对照组：给予雾化吸入氨茶碱治疗，将 10 mg 氨茶碱（国药准字 H20124248，本溪恒康制药有限公司）混入生理水 10 mL每次雾化吸入 10 min，1 次/d。联合组：在对照组治疗的基础上给予高压氧治疗，使用三舱七门高压氧舱群，空气加压的压力 0.2 mPa，加压 15 min，中间吸氧 302 min，然后均匀减压至 0 mPa 再出舱，1 次/d。两组都治疗观察 14 d。1.3 观察指标（1）在治疗前与治疗后，测定与记录所有患者血气指标，主要包括动脉血氧分压（PaO2）以及动脉二氧化碳分压（PaCO2）。（2）所有患者在治疗前后进行肺功能的测定与记录，主要为一秒用力呼气容积（Forced expiratory volume in one second,FEV1）/用力肺活量（Forced vital capacity,FVC）值。（3）所有患者在治疗后进行总体疗效评价，显效：与治疗前比较，临床症状体征有极其显著的减轻；有效：与治疗前比较，临床症状、体征有所减轻；无效：没有达到上述标准或者出现恶化。总有效率=（显效+有效）/总例数100.0%。（4）所有患者在治疗前后抽取静脉血，在 2 h 内送检测科室，采用酶联免疫法检测血清白细胞介素（Interleukin,IL）-6、IL-10 含量。（5）记录与观察两组所有患者在治疗期间出现的肝肾功能异常、感染、下肢静脉血栓、尿潴留等并发症情况。1.4 统计方法运用软件 SPSS19.00 展开分析，当 P0.05，则表明存在显著差异。利用均数标准差来描述计量数据，采用%来描述计数数据，两两对比开展 t 检验与卡方 x2检验，检验水准为=0.05。2 结果2.1 血气指标变化对比两组治疗后的 PaO2值显著升高，PaCO2值显著降低，对比存在明显差异，治疗后联合组的 PaCO2、PaO2值与对照组对比存在明显差异（P0.05）。详见表 2。2.2 总有效率对比联合组治疗后的总有效率为 97.6%，显著高于对照组的83.3%（P0.05）。详见表 3。2.3 肺功能变化对比治疗后联合组与对照组的 FEV1/FVC 值都明显高于治疗前，联合组明显高于对照组（P0.05）。详见表 4。83现代生物医学进展Progress in Modern Biomedicine Vol.23NO.1JAN.2023Note:aP0.05 compared with that pretherapy;bP0.05 when compared with the matched group after treatment,the same below.2.4 炎症因子表达变化对比治疗后联合组与对照组的血清 IL-6、IL-10 水平均下降，且联合组较对照组低（P0.05）。详见表 5。表 2 治疗前后两组患者血气指标变化对比(mmHg，均数标准差)Table 2 Comparison of blood gas index changes before and after treatment(mmHg,mean standard deviation)GroupsnPaO2PaCO2PretherapyPost-treatmentPretherapyPost-treatmentJoint group4250.552.8485.373.39ab78.933.9545.204.21abMatched group4250.113.3873.674.44a78.244.1355.392.99a表 3 治疗后总有效率对比(n)Table 3 Comparison of total response rat