Effects of salmeterol ticasone aerosol combined with ASV on respiratory function and the expression of AAG and ST2 in patients with emergency respiratory failure
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摘要: 目的 分析沙美特罗替卡松气雾剂配合适应性支持通气(ASV)对急诊呼吸衰竭患者呼吸功能及α1-酸性糖蛋白(AAG)、可溶性ST2(ST2)表达的影响。方法 前瞻性收集2020年1月—2022年1月于我院急诊科救治的呼吸衰竭患者163例为研究对象，按照随机数字法分为ASV组78例、联合治疗组85例。ASV组采用ASV进行单一治疗，联合治疗组在ASV组基础上配合沙美特罗替卡松气雾剂联合治疗。观察两组研究对象动脉血气指标、机械通气时间、ICU住院时间、病死率，血清N-末端B型利钠肽原(NT-proBNP)、C反应蛋白(CRP)、丙二醛(MDA)、超氧化物歧化酶水平，呼吸功能，AAG、ST2表达以及治疗效果。结果 联合治疗组乳酸(Lac)和病死率低于ASV组，pH值和氧合指数(OI)高于ASV组，机械通气时间和ICU住院时间短于ASV组，差异有统计学意义(P＜0.05)。联合治疗组血清NT-proBNP、CRP、MDA水平低于ASV组，血清SOD高于ASV组，差异有统计学意义(P＜0.05)。联合治疗组静态顺应性(Cst)高于ASV组，内源性呼吸末正压(PEEPi)和气道阻力低于ASV组，差异有统计学意义(P＜0.05)。联合治疗组AAG、ST2表达低于ASV组，差异有统计学意义(P＜0.05)。联合治疗组治疗总有效率高于ASV组(P＜0.05)。结论 沙美特罗替卡松气雾剂配合ASV可有效改善急诊呼吸衰竭患者血氧状态、呼吸功能，缓解机体炎症反应、氧化应激反应，降低AAG、ST2表达，缩短机械通气时间。
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关键词:
- 沙美特罗替卡松气雾剂 /
- 适应性支持通气 /
- 呼吸衰竭 /
- α1-酸性糖蛋白 /
- 可溶性ST2
Abstract: Objective To analyze the effect of salmeterol and ticasone aerosol combined with adaptive support ventilation(ASV) on respiratory function and respiratory function in patients with emergency respiratory failure α The expression of 1-acid glycoprotein(AAG) and soluble ST2(ST2).Methods One hundred and sixty-three patients with respiratory failure treated in the emergency department of our hospital from January 2020 to January 2022 were prospectively collected as the research objects. They were randomly divided into 78 cases in ASV group and 85 cases in combined treatment group. ASV group was treated with ASV alone, and the combined treatment group was treated with salmeterol ticasone aerosol on the basis of ASV group. The arterial blood gas index, mechanical ventilation time, serum N-terminal B-type natriuretic peptide(NT-proBNP), C-reactive protein(CRP), malondialdehyde(MDA) and superoxide dismutase(SOD) levels, respiratory function, AAG and ST2 expression and treatment effect were observed.Results The oxygenation index(Lac) and mechanical ventilation index(OI) were lower in the combined treatment group(P < 0.05). The levels of serum NT-proBNP, CRP and MDA in the combined treatment group were lower, and the serum SOD was higher(P < 0.05). Static compliance(Cst) was higher, endogenous positive end respiratory pressure(PEEPi) and airway resistance were lower in the combined treatment group(P < 0.05). The expressions of AAG and ST2 were lower in the combined treatment group(P < 0.05). The total effective rate of the combined treatment group was higher(P < 0.05).Conclusion Salmeterol ticasone aerosol combined with ASV can effectively improve the blood oxygen status and respiratory function of patients with emergency respiratory failure, alleviate the inflammatory reaction and oxidative stress reaction, reduce the expression of AAG and ST2, and shorten the time of mechanical ventilation. -
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表 1 两组基线资料比较
X±S 组别 例数 性别/例 平均年龄/岁 平均发病时间/d 入院时平均心率/(次·min-1) APACHE Ⅱ评分/分 诱发原因/例 男 女 重症哮喘 心源性肺水肿 社区获得性肺炎 其他 ASV组 78 37 41 58.23±6.14 2.15±0.24 96.35±3.46 21.09±2.09 16 18 16 28 联合治疗组 85 46 39 58.41±6.08 2.19±0.22 96.41±3.42 21.06±2.14 19 15 14 37 χ2/t 0.727 0.188 1.110 0.111 0.090 1.612 P 0.394 0.851 0.269 0.912 0.928 0.657 
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表 2 ASV组和联合治疗组动脉血气指标、机械通气时间、ICU住院时间、病死率比较
X±S 组别 例数 Lac/(mmol·L-1) pH值 OI/mmHg 机械通气时间/d ICU住院时间/d 病死率/% 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 ASV组 78 2.57± 0.28 1.87± 0.19 7.13± 0.72 7.26± 0.73 199.86± 20.06 284.07± 28.43 14.29± 1.48 22.65± 2.28 37.18 (29/78) 联合治疗组 85 2.53± 0.33 1.56± 0.17 7.15± 0.69 7.58± 0.79 199.83± 20.09 305.46± 30.57 10.36± 1.07 16.39± 1.62 16.47 (14/85) t/χ2 0.831 10.990 0.181 2.679 0.010 4.614 19.540 20.330 8.982 P 0.407 0.001 0.567 0.008 0.992 0.001 0.001 0.001 0.003
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表 3 ASV组和联合治疗组血清指标比较
X±S 组别 例数 NT-proBNP/(pg·mL-1) CRP/(mg·L-1) MDA/(μmol·L-1) SOD/(U·L-1) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 ASV组 78 783.46± 78.35 213.65± 21.38 36.85± 3.69 24.17± 2.43 9.86± 0.99 7.51± 0.78 57.63± 5.78 81.57± 8.16 联合治疗组 85 783.51± 78.26 187.46± 18.77 36.82± 3.74 19.85± 1.93 9.84± 1.03 6.13± 0.64 57.66± 5.74 92.34± 9.25 t 0.004 8.326 0.051 12.620 0.126 12.390 0.033 7.854 P 0.997 0.001 0.959 0.001 0.90 0.001 0.974 0.001
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表 4 ASV组和联合治疗组呼吸功能比较
X±S 组别 例数 Cst/(mL·mH2O-1) PEEPi/cmH2O 气道阻力/(cmH2O·L-1·s-1) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 ASV组 78 21.56±2.17 26.78±2.69 8.15±0.83 6.35±0.64 21.59±2.24 18.79±1.93 联合治疗组 85 21.53±2.21 30.56±3.08 8.19±0.79 4.67±0.48 21.54±2.28 16.35±1.64 t 0.087 8.313 0.315 19.060 0.141 8.720 P 0.931 0.001 0.753 0.001 0.888 0.001
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表 5 ASV组和联合治疗组AAG、ST2表达比较
X±S 组别 例数 AAG/(g·L-1) ST2/(ng·L-1) 治疗前 治疗后 治疗前 治疗后 ASV组 78 8.67±0.91 3.24±0.36 526.13±52.64 184.26±18.44 联合治疗组 85 8.73±0.85 1.38±0.15 526.18±52.58 133.52±13.38 t 0.435 43.690 0.006 20.220 P 0.664 0.001 0.955 0.001
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表 6 两组疗效果比较
例(%) 组别 例数 显效 有效 无效 治疗总有效率 ASV组 78 41 27 10 68(87.18) 联合治疗组 85 59 23 3 82(96.71) χ2 4.784 P 0.029
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