目的 探討雙水平氣道正壓通氣( BiPAP) 呼吸機加平臺呼氣閥( PEV) 聯合呼吸興奮劑治療慢性阻塞性肺疾病急性加重( AECOPD) 合并肺性腦病的療效。方法 70 例AECOPD 合并肺性腦病的患者隨機分為治療組和對照組。兩組均予以抗感染、解痙平喘、止咳祛痰等常規(guī)治療, 根據痰培養(yǎng)及藥敏結果應用敏感抗生素, 并使用BiPAP 呼吸機治療。治療組在此基礎上加PEV, 并加用納洛酮和尼可剎米靜滴治療( 療程3 d) 。觀察兩組神志轉清時間、生命體征、動脈血氣、APACHEⅡ評分及不良反應。結果 治療組與對照組相比, 治療后心率、呼吸頻率、PaCO2 及APACHEⅡ評分均明顯下降, 神志轉清時間縮短, PaO2 、SaO2 、pH 值及格拉斯哥昏迷評分明顯上升, 差異均具有統計學意義( P lt;0. 01) 。治療組2 例因療效不佳行氣管插管機械通氣, 死亡1 例。對照組5 例因療效不佳行氣管插管機械通氣, 死亡2 例。結論 早期使用BiPAP 呼吸機加PEV 聯合呼吸興奮劑治療AECOPD合并肺性腦病患者, 能明顯改善癥狀, 縮短神志轉清時間, 減少氣管插管, 迅速糾正低氧血癥和CO2 潴留, 療效顯著。
引用本文： 王永,范遠威,朱寶山. 治療COPD 肺性腦病的臨床研究. 中國呼吸與危重監(jiān)護雜志, 2010, 9(4): 344-347. doi: 復制
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- 1. Keenan SP, Sinuff T, Cook DJ, et al. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med, 2003 , 138: 861-870.
- 2. Hilbert G, Gruson D, Portel L, et al. Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency. Eur Respir J, 1998, 11 : 1349 -1353.
- 3. 中華醫(yī)學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南( 2007 年修訂版) . 中華結核和呼吸雜志, 2007 ,30: 8-17.
- 4. Díaz GG, Alcaraz AC, Talavera JC, et al. Noninvasive positivepressure ventilation to treat hypercapnic coma secondary to respiratory failure. Chest, 2005, 127: 952 -960.
- 5. Plant PK, Owen JL, Parrott S, et al. Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial.BMJ, 2003, 326: 956 .
- 6. Confalonieri M, Garuti G, Cattaruzza MS, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J, 2005, 25: 348-355 .
- 7. Schettino GP, Chatmongkolchart S, Hess DR, et al. Position of exhalation port and mask design affect CO2 rebreathing during noninvasive positive pressure ventilation. Crit Care Med, 2003, 31 :2178-2182.