右美托咪定对基于NIPPV治疗AECOPD并II型呼衰患者的疗效探讨

Discussion on Therapeutic Effect of Dexmedetomidine on NIPPV-Based Treatment of AECOPD Patients with Type II Respiratory Failure

摘要: 目的：观察右美托咪定(DEX)对于AECOPD合并II型呼衰患者，在应用无创正压通气(NIPPV)治疗过程中的作用，探讨DEX对患者机体炎症、免疫的影响。方法：选取2018年12月~2019年10月我院收治的40例AECOPD合并II型呼吸衰竭患者，随机分为观察组及对照组各20例。观察组在对照组治疗的基础上，给予DEX微量泵入。比较治疗前后两组的HR、RR、平均动脉压(MAP)及动脉血PO₂、PCO₂变化；采用ELISA法测定患者IL-1、IL-6、TNF-α、IL-10、IL-37的表达；采用流式细胞术测定CD3⁺、CD4⁺、CD8⁺ T细胞数及CD4⁺/CD8⁺比值。结果：1) 两组患者年龄、性别、体重、APACHE II评分比较，无统计差异(P > 0.05)。2) 观察组患者治疗后48 h及72 h的HR、MAP、RR及PaO₂、PaCO₂比较，观察组比对照组改善更明显，差异均有统计学意义(P < 0.05)。3) 两组间比较，观察组72 h TNF-α、IL-1β及IL-6均较对照组低，具有统计学意义(P < 0.05)，观察组IL-10在48 h、72 h时均较对照组高，但不具有统计学意义(P > 0.05)；观察组IL-37在24 h，48 h均比对照组高，但在72 h比对照组低，差异无统计学意义(P > 0.05)。4) 观察组T72 h时的CD3⁺、CD4⁺、CD4⁺/CD8⁺均较对照组高，差异具有统计学意义(P < 0.05)。结论：DEX联合NIPPV可减轻AECOPD合并II型呼衰患者炎症反应及CD3⁺、CD4⁺、CD4⁺/CD8⁺下降幅度，改善细胞免疫抑制状态，调节机体免疫功能，改善预后，带来临床获益。

Abstract: Objective: To observe the effect of dexmedetomidine (DEX) in the treatment of non-invasive positive pressure ventilation (NIPPV) in acute exacerbation chronic obstructive pulmonary disease (AECOPD) patients with type II respiratory failure, to explore the effect of DEX on inflammatory response and immune function of patients. Methods: From December 2018 to October 2019, 40 patients with AECOPD and type II respiratory failure were selected, according to the principle of random distri-bution, the patients were divided into two groups: the observation group and the control group, 20 patients in each group. While the observation group was on the basis of treatment in the control group, it was given DEX. The following indexes were compared before and after treatment: 1) HR, RR, MAP and arterial blood gas indexes; the expression of IL-1, IL-6, TNF-α, IL-10 and IL-37 were measured by enzyme-linked immunosorbent assay in the venous blood. The number of CD3⁺, CD4⁺, CD8⁺ T cells and the ratio of CD4⁺/CD8⁺ were measured by flow cytometry. Results: 1) There was no significant difference in age, sex, weight and Apache II score between the two groups (P > 0.05). 2) The HR, MAP, RR, PaO₂ and PaCO₂ of the patients in the observation group improved more signifi-cantly than those in the control group at 48 h and 72 h after treatment (P < 0.05). 3) The levels of TNF-α, IL-1β and IL-6 in the observation group were lower than those in the control group at 72 h (P < 0.05). The levels of IL-10 in the observation group were higher than those in the control group at 48 h and 72 h (P > 0.05). The level of IL-37 in the observation group was higher than that in the control group at 24 h and 48 h, but lower at 72 h (P > 0.05). 4) Compared with the control group, the CD3⁺, CD4⁺, CD4⁺/CD8⁺ in the observation group at T72 h were higher, the difference was statistical-ly significant (P < 0.05). Conclusions: The combination of DEX and NIPPV could reduce the inflam-matory reaction and decrease the levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺, improve the state of cellular im-munosuppression, regulate the immune function and improve the prognosis of patients with AECOPD and type II respiratory failure.