摘要
目的探讨双水平无创正压通气(BIPAP)联合呼吸兴奋剂用于慢性阻塞性肺疾病(COPD合并肺性脑病中的临床疗效。方法 60例COPD合并肺性脑病患者,采用随机对照法分为对照组和治疗组,每组30例。对照组在接受常规药物治疗的同时给予双水平无创正压通气,治疗组在对照组治疗的基础上联合应用呼吸兴奋剂治疗。比较两组患者治疗前以及治疗后2、48 h的呼吸频率(RR)、心率(HR)、pH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)、氧合指数(PaO2/FiO2),气管插管率,病死率,住院天数。结果治疗后2、48 h,两组患者RR、HR、pH、PaO2、PaCO2、SaO2、PaO2/FiO2水平均优于治疗前,治疗后48 h,两组患者RR、HR、pH、PaO2、PaCO2、SaO2、PaO2/FiO2水平均优于治疗后2 h,差异均具有统计学意义(P<0.05)。治疗后2 h,治疗组患者RR(24.16±3.78)次/min、HR(92.96±12.36)次/min、pH(7.30±0.08)、PaCO2(70.41±14.82)mm Hg(1 mm Hg=0.133 kPa)与对照组的(21.03±1.42)次/min、(86.30±13.34)次/min、(7.35±0.06)、(78.70±6.18)mm Hg比较,差异具有统计学意义(P<0.05)。两组患者PaO2、SaO2、PaO2/FiO2水平比较,差异均无统计学意义(P>0.05);治疗后48 h,治疗组患者RR(18.06±1.63)次/min、PaCO2(62.56±9.01)mm Hg与对照组的(19.86±1.61)次/min、(70.34±6.31)mm Hg比较,差异具有统计学意义(P<0.05)。两组患者HR、pH、PaO2、SaO2、PaO2/FiO2水平比较,差异均无统计学意义(P>0.05)。治疗组患者气管插管率16.7%、病死率13.3%及住院天数(15.76±9.23)d与对照组的10.0%、10.0%、(12.95±5.00)d比较,差异均无统计学意义(P>0.05)。结论在水平无创正压通气的基础上联合应用呼吸兴奋剂治疗COPD合并肺性脑病患者的治疗效果更加明显,可以更好的改善二氧化碳潴留,值得临床推广。
Objective To discuss the clinical efficacy of bi-level positive airway pressure (BIPAP)ventilation combined with respiratory stimulants in the treatment of chronic obstructive pulmonary disease(COPD) complicated with pulmonary encephalopathy.Methods A total of 60 cases of COPD complicated with pulmonary encephalopathy were divided into control group and treatment group according to randomized control trial,with 30 cases in each group.The control group was treated with bi-level positive airway pressure ventilation while receiving conventional drug therapy,while the treatment group was treated with respiratory stimulants on the basis of the control group.The respiratory rate (RR),heart rate (HR),pH,arterial partial pressure of oxygen(PaO2),partial pressure of carbon dioxide (PaCO2),blood oxygen saturation (SaO2),oxygenation index (PaO2/FiO2)before treatment and at 2 and 48 h after treatment,endotracheal intubation rate,mortality rate and hospitalization time were compared between the two groups.Results At 2 and 48 h after treatment,RR,HR,pH,PaO2,PaCO2,SaO2,PaO2/FiO2 of the two groups were better than those before treatment,and RR,HR,pH,PaO2,PaCO2,SaO2,PaO2/FiO2 of the two groups at 48 h after treatment were better than those 2 h after treatment,and the difference was statistically significant(P<0.05).At 2 h after treatment,RR (24.16±3.78) times/min,HR (92.96±12.36) times/min,pH (7.30±0.08),PaCO2 (70.41±14.82) mm Hg (1 mm Hg=0.133 kPa) of the treatment group had statistically significant difference compared with (21.03±1.42) times/min,(86.30±13.34) times/min,(7.35±0.06),(78.70±6.18) mm Hg of the control group (P<0.05).There was no statistically significant difference in PaO2,SaO2 and PaO2/FiO2 between the two groups (P>0.05).At 48 h after treatment,RR (18.06±1.63) times/min,PaCO2 (62.56±9.01) mm Hg of the treatment group had statistically significant compared with (19.86±1.61) times/min,(70.34±6.31) mm Hg of the control group (P<0.05);there was no statistically significant difference in HR,pH,PaO2,SaO2,PaO2/FiO2 between the two groups (P>0.05).The endotracheal intubation rate 16.7%,mortality rate 13.3%and hospitalization time (15.76±9.23) d of the treatment group had no statistically significant difference compared with 10.0%,10.0%and (12.95±5.00) d of the control group (P>0.05).Conclusion On the basis of bi-level positive airway pressure ventilation,the combined use of respiratory stimulants shows obvious effect in COPD patients with pulmonary encephalopathy,which can better improve carbon dioxide retention,which is worthy of clinical promotion.
作者
解建茹
姚燕
郝永刚
XIE Jian-ru;YAO Yan;HAO Yong-gang(Beijing Miyun District Hospital,Beijing 101500,China)
出处
《中国实用医药》
2020年第29期4-7,共4页
China Practical Medicine
关键词
双水平无创正压通气
呼吸兴奋剂
慢性阻塞性肺疾病
肺性脑病
Bi-level positive airway pressure ventilation
Respiratory stimulants
Chronic obstructive pulmonary disease
Pulmonary encephalopathy
