【摘要】 目的探讨异丙托溴铵联合布地奈德呼吸机雾化吸入治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的效果。方法 60例接受气管插管和机械通气的COPD合并呼吸衰竭病例随机分为两组:研究组、对照组各30例,研究组给予异丙托溴胺溶液2mL加布地奈德2mL×4次/d雾化吸入治疗,对照组予生理盐水4mL×4次/d雾化吸入治疗。观察治疗前后24h两组患者气道峰压(Ppeak)、平台压(Pplat)、气道阻力(Raw)、动脉血气变化,呼吸机相关性肺炎发生率、机械通气时间、住院时间的差异。结果治疗前研究组、对照组气道峰压Ppeak、平台压Pplat、气道阻力(Raw)、pH值、PaO2值及PaCO2值对比差异均无显著性(P>0.05);治疗后24h后研究组气道峰压Ppeak、平台压Pplat、气道阻力(Raw)PaCO2值均低于对照组(P<0.01);治疗24h后研究组pH值、PaO2值均高于对照组,(P<0.01);研究组、对照组呼吸机相关性肺发生率分别为30%和47%,(P<0.01);机械通气时间为(8.2±3.2)d和(11.6±5.6)d,P<0.01;住院时间为(16.3±7.4)d和(21.6±10.4)d,P<0.01。结论异丙托溴铵联合布地奈德呼吸机雾化吸入治疗COPD合并呼吸衰竭可以降低气道压力和气道阻力,改善血气指标,降低呼吸机相关肺炎发生率,缩短机械通气时间和住院时间。更多还原

【Abstract】 【Objective】 To determine the effect of Nebulized Ipratropium bromide combined budesonide in ventilated patients with chronic obstructive pulmonary disease complicated respiratory failure.【Methods】 60 intubated and ventilated complicated with respiratory failure COPD patients were randomLy divided into two groups.30 patients in study group received ipratropium bromide solution 2mL and budesonide 2mL×4 times/d nebulization,30 patients in control group received normal saline 4mL×4 times/d nebulization.Peak airway pressure(Ppeak),plateau pressure(Pplat),airway resistance(Raw),pH,PaO2 and PaCO2 were observed before and after 24h treatment.Incidence of ventilator-associated pneumonia(VAP),mechanical ventilation time,the length of hospital stay were analyzed in two groups.【Results】 The level of Ppeak,Pplat,Raw,pH,PaO2 and PaCO2 were no significant difference between two groups before treatment(P>0.05).The level of Ppeak,Pplat,Raw,PaCO2 in study group were lower than those in control group after 24h of treatment(P<0.01);the level of the pH,PaO2 in study group were higher than those in control group(P<0.01);incidence of VAP respective 30% vs 47%,(P<0.01);the duration of ventilation study group(8.2±3.2)d vs control group(11.6±5.6)d,P<0.01;the length of hospital stay respective(16.3±7.4) d vs(21.6±10.4) d,P<0.01.【Conclusion】 Nebulized Ipratropium bromide combined budesonide in ventilated patients with chronic obstructive pulmonary disease complicated respiratory failure can reduce airway pressure and airway resistance,improve blood gas analysis,reduce the incidence of VAP,shorten duration of ventilation and the length of hospital stay.更多还原