Effect of noninvasive positive pressure ventilation combined with nebulization on patients with exacerbation of chronic obstructive pulmonary disease

doi:10.3877/cma.j.issn.1674-6880.2018.04.006

Abstract

Abstract:

Objective

To analyze the clinical effect of noninvasive positive pressureventilation combined with budesonide and ipratropium nebulization and the changes of serum CC-chemokine ligand 18 (CCL-18) and growth differentiation factor 15 (GDF-15) in patients with chronic obstructive pulmonary disease (AECOPD).

Methods

Eighty AECOPD patients in Changzhou Traditional Chinese Medicine Hospital were randomly divided into the observation group (n= 40) and control group (n= 40). The control group was treated with positive pressure ventilation, and the observation group was treated with noninvasive positive pressure ventilation combined with budesonide and ipratropium nebulization. The clinical efficacy, dyspnea score, pulmonary function, arterial blood gas and serum CCL-18 and GDF-15 levels before and 72 hours after treatment in both groups were evaluated. Meanwhile, the occurrence of adverse reactions in patients was recorded.

Results

The clinical effective rate of the observation group was significantly higher than that of the control group [80.00% (32/40) vs. 67.50% (27/40), χ²= 4.036, P= 0.045]. The expressions of forced expiratory volume in one second (FEV1) [(1.69 ± 0.23) L vs. (1.43 ± 0.19) L], ratio of FEV1/forced vital capacity (FEV1/FVC) [(71 ± 4)% vs. (65 ± 4)%], peak expiratory flow (PEF) [(3.98 ± 0.27) L/s vs. (3.15 ± 0.31) L/s], dyspnea score [(1.02 ± 0.27) vs. (1.65 ± 0.32)], alveolar oxygen partial pressure (PaO₂) [(87.4 ± 1.8) mmHg vs. (70.2 ± 2.0) mmHg], partial pressure of carbon dioxide in artery (PCO₂) [(41 ± 5) mmHg vs. (59 ± 3) mmHg], pH [(7.43 ± 0.03) vs. (7.33 ± 0.02)], arterial oxygen saturation (SaO₂) [(95.7 ± 2.1)% vs. (91.2 ± 2.1)%], CCL-18 [(1.13 ± 0.12) μg/L vs. (1.68 ± 0.21) μg/L] and GDF-15 [(0.61 ± 0.12) μg/L vs. (1.02 ± 0.22) μg/L] after treatment of these two groups were statistically significantly different (t= 3.968, 8.011, 9.387, 6.870, 47.220, 19.562, 13.519, 12.385, 10.386, 10.347; all P < 0.05). The FEV1, FEV1/FVC, PEF, dyspnea score, PaO₂, PCO₂, pH, SaO₂, CCL-18 and GDF-15 levels before and after treatment in the observation group were significantly different (t= 6.3111, 21.727, 12.276, 20.406, 68.100, 27.028, 14.952, 24.845, 21.361, 35.294; all P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups [12.50% (5/40) vs. 17.50% (7/40); χ²= 0.980, P= 0.322].

Conclusion

Noninvasive positive pressure ventilation combined with budesonide and ipratropium nebulization can significantly improve the clinical efficacy and levels of serum CCL-18 and GDF-15 in AECOPD patients.

Key words: Noninvasive positive pressure ventilation, Budesonide, Ipratropium, Exacerbation of chronic obstructive pulmonary disease, Pulmonary activation regulatory chemokine 18, Growth differentiation factor 15

Qunfeng Xu, Huiping Ni. Effect of noninvasive positive pressure ventilation combined with nebulization on patients with exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(04): 244-249.

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组别	例数	年龄（岁， ± s)	性别比（例，男/女）	病程（年， ± s)	严重程度[例(%)]		合并症[例(%)]
组别	例数	年龄（岁， ± s)	性别比（例，男/女）	病程（年， ± s)	中度	轻度	高血压	CHD	糖尿病
观察组	40	64 ± 7	28/12	23 ± 5	9(22.50)	31(77.50)	17(42.50)	11(27.50)	12(30.00)
对照组	40	65 ± 8	26/14	24 ± 5	11(27.50)	29(72.50)	15(37.50)	12(30.00)	13(32.50)
t/χ²值	?	0.627	0.570	0.897	0.667		0.521
P值	?	0.532	0.450	0.373	0.414		0.771

组别	例数	年龄（岁， ± s)	性别比（例，男/女）	病程（年， ± s)	严重程度[例(%)]		合并症[例(%)]
组别	例数	年龄（岁， ± s)	性别比（例，男/女）	病程（年， ± s)	中度	轻度	高血压	CHD	糖尿病
观察组	40	64 ± 7	28/12	23 ± 5	9(22.50)	31(77.50)	17(42.50)	11(27.50)	12(30.00)
对照组	40	65 ± 8	26/14	24 ± 5	11(27.50)	29(72.50)	15(37.50)	12(30.00)	13(32.50)
t/χ²值	?	0.627	0.570	0.897	0.667		0.521
P值	?	0.532	0.450	0.373	0.414		0.771

组别		例数	FEV1(L)	FEV1/FVC(%)	PEF(L/s)
观察组		40	?	?	?
?	治疗前	?	1.20 ± 0.27	55 ± 4	2.54 ± 0.48
?	治疗后	?	1.69 ± 0.23^ab	71 ± 4^ab	3.98 ± 0.27^ab
对照组		40	?	?	?
?	治疗前	?	1.19 ± 0.28	56 ± 4	2.58 ± 0.39
?	治疗后	?	1.43 ± 0.19^a	65 ± 4^a	3.15 ± 0.31^a

组别		例数	FEV1(L)	FEV1/FVC(%)	PEF(L/s)
观察组		40	?	?	?
?	治疗前	?	1.20 ± 0.27	55 ± 4	2.54 ± 0.48
?	治疗后	?	1.69 ± 0.23^ab	71 ± 4^ab	3.98 ± 0.27^ab
对照组		40	?	?	?
?	治疗前	?	1.19 ± 0.28	56 ± 4	2.58 ± 0.39
?	治疗后	?	1.43 ± 0.19^a	65 ± 4^a	3.15 ± 0.31^a

组别		例数	PaO₂(mmHg)	PCO₂(mmHg)	pH值	SaO₂(%)
观察组		40	?	?	?	?
?	治疗前	?	54.3 ± 2.5	82 ± 8	7.30 ± 0.03	80.8 ± 3.2
?	治疗后	?	87.4 ± 1.8^ab	41 ± 5^ab	7.43 ± 0.03^ab	95.7 ± 2.1^ab
对照组		40	?	?	?	?
?	治疗前	?	54.7 ± 2.6	83 ± 9	7.31 ± 0.04	81.0 ± 4.0
?	治疗后	?	70.2 ± 2.0^a	59 ± 3^a	7.33 ± 0.02^a	91.2 ± 2.1^a

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