【摘要】 目的观察双水平气道正压(BiPAP)无创呼吸机联合尼可刹米治疗急性加重期慢性阻塞性肺疾病(AECOPD)合并Ⅱ型呼吸衰竭、重度高碳酸血症患者的临床效果和安全性。方法以2010年1月~2013年6月广州中医药大学第三附属医院芳村分院呼吸内科收治的AECOPD合并Ⅱ型呼吸衰竭、重度高碳酸血症患者46例为研究对象,按随机原则分为两组,每组23例,其中,在常规治疗的基础上,对照组加用BiPAP治疗,观察组则在对照组的基础上加用呼吸兴奋剂尼可刹米注射液治疗,分别观察并记录两组患者治疗前及治疗后2、4、24、48 h动脉血气分析参数[血氧分压(Pa O2)、二氧化碳分压(Pa CO2)和酸碱度(p H值)]的变化情况,以及临床治疗结果 (包括住院天数、气管插管率、病死率和呼吸频率),计算其总有效率。所有数据均采用统计学软件SPSS 17.0进行处理分析。结果与治疗前比较,两组患者治疗后血气分析各项指标均有显著改善,差异有统计学意义(P<0.05)。治疗后,观察组各时间点PaCO2值均明显低于对照组,差异均有统计学意义(P<0.05);观察组气管插管率及病死率均显著低于对照组,平均住院日亦显著少于对照组,呼吸频率显著高于对照组,两组差异有统计学意义(P<0.05)。治疗后,观察组总有效率显著高于对照组(P<0.05)。结论 BiPAP无创呼吸机联合尼可刹米治疗AECOPD合并Ⅱ型呼吸衰竭、重度高碳酸症患者效果显著,安全性较高,能明显减少有创机械通气的机会,降低气管插管率,不失为一种好的治疗方法,值得推广使用。更多还原

【Abstract】 Objective To observe the clinical effect and safety of combined BiPAP ventilator and Nikethamide in AECOPD patients with type Ⅱ respiratory failure and serious hypercapnia. Methods Forty-six AECOPD patients with type Ⅱ respiratory failure and serious hypercapnia who were treated in Department of Respiratory Medicine, Fangcun Branch, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2010 to June 2013 were selected as research objects. They were divided into two groups according to random principle, with 23 cases in each group. Control group was treated with BiPAP on the basis of routine treatment. Treatment of observation group was combined with Nikethamide Injection, which was a kind of respiratory stimulant. The changes of arterial blood gasses(Pa O2, Pa CO2 and p H) and clinical therapeutic outcome(including hospitalization days, tracheal cannula rate, mortality and respiratory rate) of the patients in two groups were observed and recorded before and after treatment 2, 4, 24, 48 h and the total efficiency was calculated. All the data was processed and analyzed by statistical software SPSS 17.0. Results Compared with before treatment, the sections of the blood gas analysis of patients had significant improvements after treatment, the differences waere statistically significant(P < 0.05). PaCO2 value of different time points of observation group was lower than those of control group after treatment, the differences were statistically significant(P < 0.05). Tracheal cannula rate and death rate of observation group were lower than those of control group and average hospitalization day was less than that of control group, the respiratory rate was higher than that of control group, the differences of the two groups were statistically significant(P < 0.05). After treatment, the total effective rate of observation group was significantly higher than that of control group(P < 0.05). Conclusion The treatment of combined BiPAP ventilator and Nikethamide in AECOPD patients with type Ⅱ respiratory failure and serious hypercapnia is a kind of good therapeutic method, which can significantly reduce the use of invasive positive pressure ventilation and tracheal cannula rate, with significant curative effect and high safety and deserves to be widely used.更多还原