N-乙酰半胱氨酸雾化剂对67例AECOPD患者疗效的分析-东南大学学报医学版

N-乙酰半胱氨酸雾化剂对67例AECOPD患者疗效的分析

单位：1. 滁州市中西医结合医院呼吸科, 安徽滁州 239000;
2. 苏州市立医院呼吸科, 江苏苏州 215008

分类号：R563

出版年·卷·期（页码）：2021·40·第五期（622-626）

摘要：

目的：探讨N-乙酰半胱氨酸（NAC）雾化剂在慢性阻塞性肺疾病伴急性加重（AECOPD）患者中的临床疗效。方法：将67例AECOPD患者随机分为对照组（33例）及NAC组（34例），比较两组治疗前后临床疗效以及肺功能、血气指标变化，测定炎症指标及氧化应激指标。结果：NAC组治疗显效率、有效率及总有效率均优于对照组，差异有统计学意义（Z=2.524，P<0.05）。肺功能方面，两组治疗后较治疗前均有改善，NAC组肺功能改善程度优于对照组（均P<0.05）。血气方面，两组治疗后氧合指数均有上升，治疗后NAC组较对照组氧合指数恢复显著（Δ氧合指数22.51±6.82 vs.31.77±8.07，t=5.066，P<0.01）。治疗后两组炎症指标（CPR、PCT）均有下降，且NAC组下降更为显著[ΔCRP-（13.76±4.78）vs.-（21.62±6.77），t=5.475，P<0.01；ΔPCT-（1.54±0.34）vs.-（2.34±0.56），t=7.042，P<0.01]。两组治疗前SOD、MDA无差异。治疗后NAC组SOD增加值较对照组高，差异有统计学意义（ΔSOD 22.70±5.38 vs.8.45±2.11，t=14.191，P<0.01）；NAC组MDA值下降较对照组显著，差异有统计学意义[ΔMDA-（5.51±1.29）vs.-（2.12±0.54），t=13.954，P<0.05]。NAC组预后较对照组好。结论：NAC雾化剂治疗AECOPD患者，可有效改善肺功能及氧合指数，减轻炎症反应和氧化应激。

Objective: To observe the clinical effect of N-acetylcysteine (NAC) inhalation in treating patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD). Methods: 67 patients with AECOPD were randomly divided into two group. The control group(n=33)received conventional therapy,while the NAC group(n=34)received additional NAC inhalation. The clinical efficacy, pulmonary function(FEV₁% prd,FEV₁/FVC%), blood gas analysis (oxygenation index,PaCO₂)before and after treatment were compared between the two groups. the changes in inflammation levels(CRP,PCT) and oxidative stress levels(SOD,MDA) were measured. Results: The excellent effective rate, effective rate and total effective rate of the NAC group were better than those of the control group. Both groups improved pulmonary function after treatment, and the improvement of the NAC group was better than that of the control group(all P<0.05). In terms of blood gas, the oxygenation index of the two groups increased before and after treatment, and the oxygenation index of the NAC group recovered significantly compared with the control group after treatment(Δoxygenation index 22.51±6.82 vs. 31.77±8.07,t=5.066,P<0.01). The decrease in the NAC group was more significant after treatment with inflammation levels[ΔCRP-(13.76±4.78) vs.-(21.62±6.77),t=5.475,P<0.01;ΔPCT-(1.54±0.34) vs.-(2.34±0.56),t=7.042,P<0.01]. In terms of oxidative stress indicators, there was no significant difference in SOD and MDA between the two groups before treatment. After treatment the increase in SOD in the NAC group was higher than that in the control group(ΔSOD 22.70±5.38 vs. 8.45±2.11, t=14.191, P<0.01). The MDA value of the NAC group decreased significantly than that of the control group[ΔMDA -(5.51±1.29) vs. -(2.12±0.54),t=13.954,P<0.05]. The prognosis of the NAC group was better than that of the control group. Conclusion: NAC inhalation treatment of AECOPD patients can effectively improve pulmonary function and oxygenation, reduce inflammation and oxidative stress.

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