Noninvasive ventilation combined with Symbicort on HACOR score and COX-2,MCP-1,and PLA2 levels in AECOPD patients with respiratory failure

Jiang Lili; Duan Jun; Ge Yanlei; Deng Zhiping; Wu Ju; Guan Liping; He Tingting; Chen Ying

doi:10.11986/j.issn.1673-873X.2025.01.10

Abstract：Objective To investigate the effects of noninvasive positive pressure ventilation(NIPPV)combined with Symbi-cort on the HACOR score(an index predicting NIPPV failure)and on serum levels of cyclooxygenase-2(COX-2),monocyte chemoattractant protein-1(MCP-1),and phospholipase A2(PLA2)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by respiratory failure,to inform clinical decisionmaking.Methods From March 2023 to May 2024,180 AECOPD patients with respiratory failure admitted to the Zigong First People's Hospital were en-rolled and randomized into a conventional group(conventional pharmacotherapy+NIPPV,n=90)and a Symbicort group(NIPPV+Symbicort,n=90).The time to dyspnea relief,duration of mechanical ventilation,and length of stay in the re-spiratory intensive care unit(RICU).HACOR and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)scores,arterial blood gas indices[partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygena-tion index(OI)],pulmonary artery pressures[mean pulmonary artery pressure(mPAP),pulmonary artery systolic pres-sure(PASP),pulmonary artery diastolic pressure(PADP)],serum COX-2,MCP-1,and PLA2 levels,and incidence of ad-verse reactions were assessed before and after treatment.Results The Symbicort group showed significantly shorter time to dyspnea relief,duration of mechanical ventilation,and length of RICU stay than the conventional group(all P<0.05).Pre-treatment,HACOR and APACHEⅡ scores did not differ significantly between groups(P>0.05);posttreatment,both scores decreased significantly in each group compared to baseline and were lower in the Symbicort group(P<0.05).Before treatment,there was no significant difference in OI,PaO2,and PaCO2 between the two groups(P>0.05);after treat-ment,OI and PaO2 in the two groups were increased,with Symbicort group higher than conventional group;PaCO2 in the two groups was decreased,with Symbicort group lower than conventional group,all with statistical significance(P<0.05).Before treatment,there was no significant difference in mPAP,PASP,and PADP between the two groups(P>0.05);af-ter treatment,mPAP,PASP,and PADP in the two groups were decreased,with Symbicort group significantly lower than conventional group(P<0.05).Before treatment,there was no significant difference in COX-2,MCP-1,and PLA2 between the two groups(P>0.05);after treatment,COX-2,MCP-1,and PLA2 in the two groups showed a decline,with Symbi-cort group was significantly lower than the conventional group(P<0.05).During treatment,the incidence of adverse e-vents was 3.33%in the conventional group and 5.56%in the Symbicort group,without a significant difference between the two groups(χ2=0.131,P=0.718).Conclusion NIPPV combined with Symbicort effectively relieves dyspnea,reduces pulmonary artery pressures,and attenuates systemic inflammation in AECOPD patients comorbid with respiratory failure,holding promise for a wider application.