| Objective: To observe the effect of dexmedetomidine(DEX)in the treatment of noninvasive mechanical ventilation(NIPPV)in 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,in order to find a more effective treatment plan,so as to improve the treatment compliance of AECOPD patients with type II respiratory failure,reduce the rate of tracheal intubation,and improve the prognosis of patients.Methods: from December 2018 to October 2019,40 patients with AECOPD and type II respiratory failure were selected,aged 40-80 years old,male and female.According to the guidelines of gold 2017,patients with AECOPD were diagnosed and met the diagnostic criteria of type II respiratory failure;patientsuse NIPPV without contraindications.Gold was divided into group C and group D patients;APACHE II score was 8-29 points.Excluding pregnant women,patients with other respiratory diseases other than COPD,COPD who had been treated with systemic glucocorticoids and antibiotics within 4 weeks after admission Patients with acute exacerbation of respiratory tract infection,liver and kidney dysfunction,severe cardiovascular and cerebrovascular diseases,consciousness disorders,hemodynamic instability and long-term use of sedative,analgesic drugs and antipsychotic drugs.Approved by the hospital ethics committee and informed consent of patients' families.According to the principle of random distribution,the patients were divided into two groups: the observation groupand the control group,20 patients in each group.Patients in the two groups were given routine ECG monitoring,heart rate(HR),blood pressure(BP),respiratory rate(RR)and blood gas analysis,and were given routine anti infection,antiasthmatic,expectorant drugs and NIPPV.On this basis,while the observation group was treated with the control group,it was given DEX micro pump,maintained at a dose of 0.2-0.7 ? g /(kg.h),and the sedative RASS score of 0-1 was taken as the target to adjust the dose for 72 hours.The following indexes were compared before and after treatment:(1)Clinical observation indexes: HR,RR,MAP and arterialblood gas indexes at 12 h,24h,48 h and 72 h after treatment;(2)Inflammatory indexes:before treatment(T0),24 h,48h,72 h after treatment,The expression of IL-1,IL-6,TNF-?,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 inT0,24 h,48h,72 hvenous blood;(4)Pprognosis index:record the length of stay in hospital,the cost of stay in hospital,and measure the anxiety of patients by SAS.Comparison of clinical observation indexes:(1)There was no significant difference in HR,map,RR,PaO2 and PaCO2 between the two groups before treatment(P > 0.05).(2)The HR,RR and blood gas(PaO2,PaCO2)in the control group were significantly improved(P < 0.05)at 12 h,24h,48 h and 72 h after treatment,while map was not significantly improved at 12 h and 72 h before treatment,there was no significant difference(P > 0.05),but it was significantly improved at 24 h after treatment(P < 0.05).(3)HR,map,RR,PaO2 and PaCO2 in the observation group were significantly improved at 12 h,24h,48 h and 72 h after treatment(P < 0.05).(4)Compared with HR,map,RR,PaO2 and PaCO2 in48 h and 72 h after treatment,the difference between the two groups was statistically significant(P < 0.05).There was no significant difference between the two groups at 12 h and 24h(P > 0.05).3.Comparison of inflammatory indexes:(1)compared with before treatment,TNF-?,IL-1 and IL-6 in the two groups were 24 hours respectively The difference was statistically significant(P < 0.05);the level of IL-10 increased significantly at 48 h and 72 h respectively(P < 0.05);the level of TNF-?,IL-1 ? and IL-6in the observation group(DEX group)at 48 H All of them were lower than the control group,but the difference was not statistically significant(P > 0.05).At 72 h,they were lower than the control group,with statistical significance(P < 0.05).At 48 h and 72 h,the IL-10 of the observation group was higher than the control group,but not statistically significant(P > 0.05).(3)Compared with before treatment,the two groups IL-37 increased in 24 h,significantly increased in 48 h,the difference was statistically significant(P < 0.05),decreased in 72 h,and statistically significant(P < 0.05)compared with 48h;(4)compared between the two groups,IL-37 in the observation group was higher in 24 h,48h than the control group,but lower in 72 h than the control group,but the difference was not statistically significant(P > 0.05).4.Comparison of immune indexes:(1)there was no significant difference in the levels of CD3 +,CD4 +,CD8 +,CD4 + / CD8 + between the two groups before treatment(T0)(P > 0.05);(2)compared with T0,the levels of CD3 +,CD4 +,CD4 + / CD8 + in the two groups at t48 h and t72 h were all increased,thedifference was statistically significant(P < 0.05)CD3 +,CD4 +,CD4 + / CD8 + were all increased,but the difference was not statistically significant(P > 0.05);(3)compared with the control group,the CD3 +,CD4 +,CD4 + / CD8 + in the observation group at t72 h were higher,the difference was statistically significant(P < 0.05),and the CD3 +,CD4 +,CD4 + / CD8 + in the observation group at t24 h,t48h were higher,but the difference was not statistically significant(P >0.05).5.Prognosis index: compared with the control group,the average length of stay in the observation group was shorter,and the incidence of anxiety was lower.Conclusions: 1.DEX combined with NIPPV can reduce the inflammatory response in patients with AECOPD and type II respiratory failure;2.DEX combined with NIPPV can reduce CD3 +,CD4 + in patients with AECOPD and type II respiratory failure The decrease of CD4 + / CD8 + can improve the immunosuppressive state of the patients,and reduce the inflammatory reaction by regulating the immune function of the body;3.When NIPPV is used to treat AECOPD patients with type II respiratory failure,the combination of NIPPV three days before hospitalization can significantly reduce the inflammatory reaction,improve the immune function of the body,so as to improve the success rate of disease treatment,shorten the treatment days,and reduce the occurrence of anxiety To improve the prognosis and bring clinical benefits. |
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