【摘要】 目的：探讨小剂量氨茶碱联合适应性压力支持治疗对慢性阻塞性肺疾病急性加重期（AECOPD）并发重症呼吸衰竭患者胸肺顺应性及脑氧代谢的影响。方法：收集2019年10月至2021年3月该院收治的92例AECOPD并发重症呼吸衰竭患者的临床资料进行回顾性分析，按照治疗方案不同分为观察组、对照组，各46例。对照组患者采用适应性压力支持治疗，观察组患者采用小剂量氨茶碱联合适应性压力支持治疗。比较两组患者的机械通气、住院时间，治疗前、治疗3 d后血气分析指标[氧分压（PaO₂）、二氧化碳分压（PaCO₂）、血氧饱和度（SpO₂）和二氧化碳结合力（CO₂CP）]水平、胸肺顺应性[呼吸系统顺应性(C_rs)、胸廓顺应性(C_cw)和肺顺应性（C_l）]、脑氧代谢指标[颈内静脉球部血氧饱和度（SjvO₂）、脑氧摄取率（CEO₂）和动脉动静脉血氧含量差（Ca-vO₂）]水平、炎症因子[白细胞介素（IL）17、髓样细胞触发受体-1（TREM-1）和IL-33]水平及治疗期间不良反应发生率。结果：观察组患者机械通气、住院时间较对照组更短，差异有统计学意义（P<0.05）。治疗3 d后，观察组患者PaO₂、SpO₂、C_rs、C_cw、C_l和SjvO₂较对照组更高，PaCO₂、CO₂CP、Ca-vO₂和CEO₂水平较对照组更低，差异均有统计学意义（P<0.05）。治疗3 d后，观察组患者血清IL-17、TREM-1和IL-33水平较对照组更低，差异均有统计学意义（P<0.05）。观察组、对照组患者的不良反应发生率分别为10.87%（5/46）、6.52%（3/46）,差异无统计学意义（P>0.05）。结论：小剂量氨茶碱联合适应性压力支持治疗用于AECOPD并发重症呼吸衰竭患者，可有效缩短患者机械通气、住院时间，改善呼吸状态、胸肺顺应性及脑氧代谢，减轻机体炎症，安全性较高。更多还原

【Abstract】 OBJECTIVE: To probe into the effects of low-dose aminophylline combined with adaptive stress support therapy on chest-lung compliance and cerebral oxygen metabolism in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） complicated with severe respiratory failure. METHODS: Clinical data of 92 patients with AECOPD complicated with severe respiratory failure admitted to our hospital from Oct. 2019 to Mar. 2021 were collected for retrospective analysis, which were divided into observation group and control group according to different therapeutic regimens, with 46 cases in each group. The control group was given adaptive stress support therapy, while the observation group was given low-dose aminophylline combined with adaptive stress support therapy. The duration of mechanical ventilation and length of hospital stay, blood gas indicators [oxygen partial pressure（PaO₂）, partial pressure of carbon dioxide（PaCO₂）, oxyhemoglobin saturation（SpO₂） and carbon dioxide combining power（CO₂CP）], chest-lung compliance [respiratory system compliance(C_rs), chest wide compliance(C_cw) and lung compliance（C_l）], cerebral oxygen metabolism [oxyhemoglobin saturation of jugular vein bulb（SjvO₂）, cerebral oxygen extraction rate（CEO₂） and deviation of oxyhemoglobin saturation of artery and vein（Ca-vO₂）] and inflammatory factor levels [interleukin（IL） 17, myeloid cells trigger receptors 1（TREM-1） and IL-33] before treatment and after 3 days of treatment, incidences of adverse drug reactions during treatment were compared between two groups. RESULTS: The duration of mechanical ventilation and length of hospital stay of the observation group were shorter than those of the control group, with statistically significant differences（P<0.05）. After 3 days of treatment, the PaO₂, SpO₂, C_rs, C_cw, C_l and SjvO₂ levels of observation group were higher than those of the control group, while the PaCO₂, CO₂CP, Ca-vO₂ and CEO₂ levels of observation group were lower than those of the control group, with statistically significant differences（P<0.05）. After 3 days of treatment, the serum IL-17, TREM-1 and IL-33 levels of observation group were lower than those of the control group, with statistically significant differences（P<0.05）. The incidences of adverse drug reactions of observation group and control group were respectively 10.87%（5/46） and 6.52%（3/46）, the difference was not statistically significant（P>0.05）. CONCLUSIONS: Low-dose aminophylline combined with adaptive stress support therapy in the treatment of AECOPD complicated with severe respiratory failure can effectively shorten the duration of mechanical ventilation and length of hospital stay, improve respiratory status, chest-lung compliance and cerebral oxygen metabolism, relieve body inflammation, with high safety.更多还原