摘要
目的探究尼可刹米与洛贝林联合低分子肝素对慢性阻塞性肺疾病急性加重(AECOPD)合并肺性脑病患者微循环及心肺功能影响。方法选择2019年1月至2021年12月在安徽医科大学附属亳州医院接受治疗的95例AECOPD合并肺性脑病患者作为研究对象,根据治疗方法不同分为对照组(47例)和观察组(48例),对照组在纠正水电解质、酸碱平衡、抗感染、通气治疗等综合治疗的基础上给予0.25~0.5 g尼可刹米和3 ml洛贝林静脉泵入,观察组在对照组的基础上增加皮下注射低分子肝素5000 IU,两组均维持治疗1周。比较两组治疗前后微循环指标(白微栓数量、微血管血流速度、血浆黏度)、心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]、肺功能指标[第一秒用力呼气量(FEV 1)、用力肺活量(FVC)、最大呼气峰流速(PEF)、FEV 1/FVC]以及血气指标[动脉血氧分压(PaO_(2))、pH值、动脉血二氧化碳分压(PaCO_(2))]变化。结果治疗后,观察组白微栓数量少于对照组[(1.25±0.24)个/min比(1.41±0.29)个/min],微血管血流速度快于对照组[(846.8±33.8)μm/s比(821.4±35.8)μm/s],血浆黏度低于对照组[(1.24±0.27)mPa·s比(1.43±0.30)mPa·s](均P<0.01)。治疗后,观察组LVEF高于对照组[(45.8±5.5)%比(42.4±5.6)%],LVESD和LVEDD小于对照组[(42.1±5.3)mm比(47.6±5.7)mm,(52.5±5.5)mm比(56.5±5.6)mm](均P<0.01)。治疗后,观察组FEV 1、FVC、PEF及FEV 1/FVC水平均高于对照组[(1.74±0.35)L比(1.36±0.47)L,(2.61±0.41)L比(2.26±0.36)L,(6.54±0.37)L/s比(6.26±0.41)L/s,(66.7±4.4)%比(60.2±4.2)%](均P<0.01)。治疗后,观察组PaO_(2)、pH值均高于对照组[(85.2±7.3)mmHg(1 mmHg=0.133 kPa)比(79.9±7.1)mmHg,(7.31±0.09)比(7.24±0.07)],PaCO_(2)低于对照组[(40.12±4.14)mmHg比(43.12±5.35)mmHg](均P<0.01)。结论尼可刹米与洛贝林联合低分子肝素可有效改善AECOPD合并肺性脑病患者微循环、心肺功能及血气指标水平,促进康复进程。
Objective To investigate the effects of nikethamide and lobeline combined with low molecular weight heparin on microcirculation and cardiopulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pulmonary encephalopathy.Methods A total of 95 patients with AECOPD complicated with pulmonary encephalopathy treated in Bozhou Hospital Affiliated to Anhui Medical University from Jan.2019 to Dec.2021 were selected as the research subjects,and according to different treatment methods,they were divided into a control group(47 cases)and an observation group(48 cases).The control group was given 0.25-0.5 g of nikethamide and 3 ml of lobeline intravenous pump therapy on the basis of comprehensive treatments such as correction of water electrolyte balance,acid-base balance,anti-infection,ventilation therapy,etc.The observation group was given subcutaneous injection of 5000 IU low molecular weight heparin on the basis of the control group,and both groups received above maintenance treatment for 1 week.The microcirculation indexes[number of white microthrombosis,microvascular blood flow velocity,plasma viscosity],cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)],pulmonary function indicators[forced expiratory volume in first second(FEV 1),forced vital capacity(FVC),peak expiratory flow(PEF),FEV 1/FVC]and blood gas indicators[arterial partial pressure of oxygen(PaO_(2)),pH,arterial blood carbon dioxide partial pressure(PaCO_(2))]of the two groups before and after treatment were compared.Results After treatment,the number of white microthrombus in the observation group was less than that in the control group[(1.25±0.24)/min vs(1.41±0.29)/min],the microvascular flow velocity was faster than that in the control group[(846.8±33.8)μm/s vs(821.4±35.8)μm/s],and the plasma viscosity was lower than that of the control group[(1.24±0.27)mPa·s vs(1.43±0.30)mPa·s](all P<0.01).After treatment,the LVEF in the observation group was higher than that in the control group[(45.8±5.5)%vs(42.4±5.6)%],LVESD and LVEDD were smaller than the control group[(42.1±5.3)mm vs(47.6±5.7)mm,(52.5±5.5)mm vs(56.5±5.6)mm](all P<0.01).After treatment,the levels of FEV 1,FVC,PEF and FEV 1/FVC in the observation group were higher than those in the control group[(1.74±0.35)L vs(1.36±0.47)L,(2.61±0.41)L vs(2.26±0.36)L,(6.54±0.37)L/s vs(6.26±0.41)L/s,(66.7±4.4)%vs(60.2±4.2)%](all P<0.01).After treatment,PaO_(2) and pH in the observation group were higher than those in the control group[(85.2±7.3)mmHg(1 mmHg=0.133 kPa)vs(79.9±7.1)mmHg,(7.31±0.09)vs(7.24±0.07)],PaCO_(2) was lower than the control group[(40.12±4.14)mmHg vs(43.12±5.35)mmHg](all P<0.01).Conclusion Nikethamide,lobeline combined with low molecular weight heparin can effectively improve the microcirculation,cardiopulmonary function and blood gas index levels in patients with AECOPD complicated with pulmonary encephalopathy,and promote the recovery process.
作者
张红波
蒋亚林
代慧
ZHANG Hongbo;JIANG Yalin;DAI Hui(Department of Respiratory and Critical Care Medicine,Bozhou Hospital Affiliated to Anhui Medical University,Bozhou 236800,China;Department of Neurology,Bozhou Hospital Affiliated to Anhui Medical University,Bozhou 236800,China)
出处
《医学综述》
CAS
2022年第16期3314-3318,3324,共6页
Medical Recapitulate
基金
安徽省重点研究与开发计划项目(202104j07020052)。
关键词
慢性阻塞性肺疾病急性加重
肺性脑病
尼可刹米
洛贝林
低分子肝素
微循环
Acute exacerbation of chronic obstructive pulmonary disease
Pulmonary encephalopathy
Nikethamide
Lobeline
Low molecular weight heparin
Microcirculation
