2019 年第 12 期 第 14 卷

沙丁胺醇联合甲泼尼龙对Ⅱ型呼吸衰竭患者高敏C反应蛋白和N末端B型脑钠肽前体水平及心脏功能的影响

Effect of salbutamol combined with methylprednisolone on high sensitive C-reactive protein, N-terminal pro-brain natriuretic peptide and heart function in patients with type Ⅱ respiratory failure

作者：周志翔詹茂芹姜涛

英文作者：

单位：242000安徽省宣城市人民医院急诊科

英文单位：

关键词：Ⅱ型呼吸衰竭；沙丁胺醇；甲泼尼龙

英文关键词：

• 摘要：

• 【摘要】目的    观察沙丁胺醇联合甲泼尼龙对Ⅱ型呼吸衰竭患者高敏C反应蛋白（hs-CRP）和N末端B型脑钠肽前体（NT-proBNP）水平及心脏功能的影响。方法    选取2017年6月至2018年12月于安徽省宣城市人民医院住院治疗的102例Ⅱ型呼吸衰竭患者，按密封信封法随机分为常规组和联合组，每组51例。常规组患者给予常规吸氧、祛痰、抗感染治疗；联合组在常规治疗基础上给予沙丁胺醇联合甲泼尼龙治疗，均治疗10 d。比较2组治疗前后血气指标、血清hs-CRP和NT-proBNP水平、心功能指标以及急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分的变化情况，并记录不良反应发生情况。结果    治疗后，2组氧合指数、动脉血氧分压、pH值均高于治疗前、且联合组高于常规组，动脉血二氧化碳分压、hs-CRP、NT-proBNP低于治疗前、且联合组低于常规组［（37±7）mmHg（1 mmHg=0.133 kPa）比（48±8）mmHg、（13.8±2.5）mg/L比（18.9±3.5）mg/L、（512±89）ng/L比（649±106）ng/L］，差异均有统计学意义（均P<0.05)。治疗后，2组左心室舒张末期、收缩末期内径均低于治疗前，且联合组低于常规组；左心室射血分数均高于治疗前，且联合组高于常规组［（45±7）%比（40±7）%］，差异均有统计学意义（均P<0.05)。治疗后，2组APACHEⅡ评分均低于治疗前，且联合组低于常规组［（10.1±1.9）分比（15.8±2.9）分］，差异均有统计学意义(均P<0.05)。2组不良反应发生率差异无统计学意义(P>0.05)。结论    沙丁胺醇联合甲泼尼龙治疗Ⅱ型呼吸衰竭，可显著改善患者血气参数，下调血清hs-CRP、NT-proBNP水平，减轻心脏负荷，提高患者生活质量，改善患者预后。

• 【Abstract】Objective    To observe the effect of salbutamol combined with methylprednisolone on the levels of high sensitive C-reactive protein(hs-CRP), N-terminal pro-brain natriuretic peptide(NT-proBNP) and heart function in patients with type Ⅱ respiratory failure. Methods    A total of 102 patients with type Ⅱ respiratory failure who were hospitalized in the People′s Hospital of Xuancheng City, Anhui Province from June 2017 to December 2018 were randomly divided into routine group and combination group, with 51 cases in each group. The routine group were given routine oxygen inhalation, expectoration and anti-infection treatments. The combination group was additionally given salbutamol and methylprednisolone. After 10 days of treatment, blood gas indicators, levels of serum hs-CRP and NT-proBNP, heart function indexes, score of Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) and adverse reactions were analyzed. Results    After treatment, oxygenation index, arterial partial pressure of oxygen and pH significantly increased in both groups and the indexes in the combination group were higher than those in the routine group; arterial partial pressure of carbon dioxide, serum levels of hs-CRP and NT-proBNP significantly decreased and the indexes in the combination group were lower than those in the routine group［（37±7）mmHg vs （48±8）mmHg, （13.8±2.5）mg/L vs （18.9±3.5）mg/L, （512±89）ng/L vs （649±106）ng/L］(all P<0.05). After treatment, left ventricular end-diastolic and end-systolic diameters diminished and left ventricular ejection fraction increased in both groups; left ventricular end-diastolic and end-systolic diameters in the combination group were lower and left ventricular ejection fraction［（45±7）% vs （40±7）%］ was higher than those in the routine group(all P<0.05). APACHE Ⅱ score significantly decreased after treatment and it was lower in the combination group than that in the routine group［（10.1±1.9）scores vs （15.8±2.9）scores］(all P<0.05). There was no statistical difference in the incidence rate of adverse reactions between groups(P>0.05). Conclusion    Salbutamol combined with methylprednisolone treating type Ⅱ respiratory failure can significantly improve blood gas indicatorss, reduce serum hs-CRP and NT-proBNP levels, alleviate cardiac load, improve the quality of life and prognosis of patient.