| Heliox is a gas mixtured with helium and oxygen with a lower density. Due to it's low density, it can accelerate the flow rate when flowing through the pipeline, thereby reduce the forming of turbulence, and then reduce resistance produced between the flowing gas and the tube wall. While, due to flow faster, heliox also can speed up the liquid atomization efficiency, homogenize aerosol particles, increase the adhesion rate of aerosol particles to the tube wall as the driver gas atomizing liquids. When patients with chronic obstructive pulmonary disease(COPD) inhaled heliox, the airway resistance could be reduced and gas in alveolar was expelled, thus the lung dynamic hyperinflation got improved and the intrinsic positive end expiration pressure(PEEPi) in alveolar decreased. Owing to the above result, the over-expansion alveolars retracted and the lung function got better, respiratory muscle power and respiratory muscle fatigue reduced, thereby increased exercise tolerance. Then, patients with COPD got remission.In this study, inhaled salbutamol sulfate solution and glucocorticoid budesonide inhalation suspension were atomized with heliox to treat patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The patients' normal vital signs, arterial blood gas, pulmonary function tests, lung vibration energy, difficulty in breathing rate classification and the impact of accessory muscle were recorded in order to clear whether this treatment can effect the patiets; vital signs, improve lung function and lung vibration energy, the expression of human serum myostatin. Patients were randomly divided into control group (Nitrogen70%/oxygen30%, nitron, v/v) and treatment group (70%helium/30% oxygen, heliox, v/v),14 patients in each group. Each group had beeing treated with salbutamol aerosol (2.5mg) and budesonide (1mg) for 7 days as driven gas nitron and heliox were given separately. The data were recorded such as general vital signs, arterial blood gases, lung function tests, lung vibration energy, difficulty breathing and ventilation action grading score before treatment and 1st and 2nd treatment(30 minutes after treatment), day 3,5,7(1 hour after treatment). Serum myostatin(hsMSTN) concentration was measured at the above time point.Excel and SPSS 16.0 statistical software were used for data entry and statistical analysis. The results showed that heliox significantly shortened the spray time compared to control group. The patients'heart rate, blood pressure, respiratory rate without increasing or decreasing trend, There had no statistically significance in both groups after treatment,but the heart rate in control group rose significantly during the treating period(P<0.05). Blood gas analysis showed that the partial pressure of oxygen and partial pressure of carbon dioxide in arterial blood in both groups had no change, and there had no significance between the two group(P>0.05). By baseline correction, lung function test showed that the growth rate of FEV1, FEV1/FVC, FVC and MVV showed no significant differences between the two groups during the treatment period(P>0.05),but their increase rate rose significantly compared to before treatment exept MVV increase rate(P<0.05). Lung vibration energy score and quality lung data(QLD) at different areas showed no significant difference between the two groups, but the QLD at the upper left had a significant difference before treatment and day 7 in the treatment group(P<0.05). Meanwhile, the QLD in treatment group showed a trend back to the normal reference value. sMSTN results showed that both groups had a little downward trend in each group but no significant difference had there between the two groups. Gene mutation detection fund two mutation sites on exon 2, one is glu to lys located on site E164K, one is lys to gln located on site K136Q. The former has an enhanced protein level detected in serum and the measure of lung function haven't any change.These findings suggest that application of heliox as a driving gas to automize bronchodilators and inhaled budesonide significantly shortened the time to spray drug liquid, and don't effect patients'vital sighs. There have little effect on improving arterial oxygen pressure because of the critical screen standard of arterial oxygen pressure set before, and should be related to the use of bronchodilators and inhaled low-flow oxygen(2L/min) before the study. Little change in arterial carbon dioxide partial pressure might be relatet to the limitation of arterial carbon dioxide to lower than 50mmHg. For lung function, the value of FEV1, FEV1/FVC and MVV can improve slightly as same as routine drug spray, but the increase rate got a significant improvement. The reason that lung vibration energy score did not show significance both before and after treatment scores, one could be partly because the standard single scores were influenced by the external environment at the same time, and the second reason was that chronic inflammation existed in the lungs may cause part of the expanded pulmonary alveolar structure fused together and resulted the abnormal remodeling of lung tissue. The phenomena of QLD trending to normal reference value may be related much to the gas re-contribution in alveolar for the heliox. The reasons that sMSTN showed little decrease may be one is that the treating time is too short, and another may be relate to the reduce of exercise time. Both the two gene mutation sites in the AECOPD patient located on exon 2. The amino acid at E164K of glu to lys increase the level of MSTN in serum and the K136Q is a new mutation on exon 2.On summary, the driven gas of heliox can shorten the spray of drug liquid, and have little effect on vital signs of AECOPD patients who have received drug therapy or clinical treatment. However, this treatment can improve the lung function and regulate the contribution of gas in lung tissue, thus relief the disease and worth to promotion. The new gene mutation may have the capable of screen CODP and asses the progression after therapy. |
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