慢性阻塞性肺病急性加重期合并肺性脑病患者的疗效观察
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摘要
目的:观察无创双水平气道正压(Bi PAP)通气联合纳洛酮(NLX)在慢性阻塞性肺病(COPD)急性加重期合并肺性脑病治疗中的应用。方法:选取66例COPD急性加重期合并肺性脑病患者分为两组,对照组采用吸氧、抗感染、化痰平喘常规综合治疗,观察组在此基础上使用纳洛酮首次0.8mg静脉注射,随后予3μg/(kg·h)微量泵持续静脉泵入,并持续使用Bi PAP通气,观察两组疗效。结果:两组治疗后心率、呼吸频率、血压均有显著改善(P<0.05)。对照组治疗3h后Pa O2和Sa O2增加(P<0.05),但p H值和Pa CO2均无明显改变(P均>0.05),部分患者甚至加重;24h时Pa O2维持在较高水平,p H值和Pa CO2改善仍不明显。与对照组比较,观察组治疗后各项指标均恢复正常(P<0.05)。观察组诊治时间短、气管插管率降低、病死率明显下降,这些数据与对照组相比,差异均具有统计学意义(P<0.05)。结论:Bi PAP通气联用NLX治疗COPD急性加重期合并肺性脑病的临床效果较好,插管率、病死率明显降低。
Objective:To discuss the efficacy of bi-level positive airway pressure ventilation(Bi PAP)and nal-oxone for the treatment of chronic obstructive pulmonary disease(COPD)in acute exacerbation combined with pulmonary encephalopathy. Methods:Sixy-six cases with COPD in acute exacerbation combined pulmonary encephalopathy were divided into two groups. 33 cases in control group were treated with oxygen inhalation,anti-infection and so on;33 cases treated with Bi PAP combined with naloxone on the basis of conventional treatment,naloxone 0.8mg intravenous injection for the first time,and then 3ug/kg·h by micro pump continous injection.PH,Pa O2,Pa CO2 and Sa O2 before and after treat-ment in two groups were compared,and the change of HR,RR,MAP and clinical symptoms were observed. The hospitalization time,intubation rate and mortality rate were also observed.Results:After treatment,HR,RR and blood pressure were obviously improved in two groups.Whereas Pa O2 and Sa O2 were obviously increased in control group in 3h(P<0.05).But p H and Pa CO2 were not obviously changed(P>0.05),some cases even worse; Pa O2 and Sa O2 were maintained at a high level in 24 h,p H and Pa CO2 were not obviously improved. The improvement of each index in observation group was obviously higher than that in control group after treatment,the difference had statistical significance(P<0.05). Compared with control group,observation group had shorter hospitalization time, lower intubation rate and mortality rate. The difference was obvious and had statistical significance(P<0.05). Conclusion:The treatment of COPD combined with pulmonary encephalopathy by Bi PAP and naloxone has obvious cura-tive effect. It can obviously decrease the intubation rate and mortality rate.
Objective:To discuss the efficacy of bi-level positive airway pressure ventilation(Bi PAP)and nal-oxone for the treatment of chronic obstructive pulmonary disease(COPD)in acute exacerbation combined with pulmonary encephalopathy. Methods:Sixy-six cases with COPD in acute exacerbation combined pulmonary encephalopathy were divided into two groups. 33 cases in control group were treated with oxygen inhalation,anti-infection and so on;33 cases treated with Bi PAP combined with naloxone on the basis of conventional treatment,naloxone 0.8mg intravenous injection for the first time,and then 3ug/kg·h by micro pump continous injection.PH,Pa O2,Pa CO2 and Sa O2 before and after treat-ment in two groups were compared,and the change of HR,RR,MAP and clinical symptoms were observed. The hospitalization time,intubation rate and mortality rate were also observed.Results:After treatment,HR,RR and blood pressure were obviously improved in two groups.Whereas Pa O2 and Sa O2 were obviously increased in control group in 3h(P<0.05).But p H and Pa CO2 were not obviously changed(P>0.05),some cases even worse; Pa O2 and Sa O2 were maintained at a high level in 24 h,p H and Pa CO2 were not obviously improved. The improvement of each index in observation group was obviously higher than that in control group after treatment,the difference had statistical significance(P<0.05). Compared with control group,observation group had shorter hospitalization time, lower intubation rate and mortality rate. The difference was obvious and had statistical significance(P<0.05). Conclusion:The treatment of COPD combined with pulmonary encephalopathy by Bi PAP and naloxone has obvious cura-tive effect. It can obviously decrease the intubation rate and mortality rate.
引文
[1]郑伟霞.慢性呼吸衰竭并肺性脑病应用药物早期治疗的护理观察[J].中国医药指南,2013,23:15-17.
[2]黄卫华,李玉,范风燕,等.老年慢性阻塞性肺疾病合并肺性脑病的护理[J].实用临床医药杂志,2013,12:25-30.
[3]刘亚平.肺性脑病50例临床分析[J].中国实用神经疾病杂志,2013,8:2-7.
[4]刘晨,赵雅宁,葛晓励,等.肺性脑病患者认知障碍临床分析[J].河北联合大学学报(医学版),2013,1:198-201.
[5]朱卫锋.肺性脑病与动脉血气关系临床分析[J].临床肺科杂志,2012,6:123-145.
[6]孙琼.老年人肺性脑病的诱因分析及护理对策[J].当代护士(下旬刊),2012,4:96-98.
[7]刘继权,俞兴群.中医药治疗AECOPD呼吸衰竭的研究现状[J].中医药临床杂志,2014,9:252-261.
[8]袁顺蓉,邓旭,陶冠宇,等.有创无创序贯机械通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床研究[J].西部医学,2014,9:1245-1251.
[9]谢东,卢国良.中西医结合治疗慢性阻塞性肺疾病并呼吸衰竭临床研究[J].四川中医,2014,9:301-308.
[2]黄卫华,李玉,范风燕,等.老年慢性阻塞性肺疾病合并肺性脑病的护理[J].实用临床医药杂志,2013,12:25-30.
[3]刘亚平.肺性脑病50例临床分析[J].中国实用神经疾病杂志,2013,8:2-7.
[4]刘晨,赵雅宁,葛晓励,等.肺性脑病患者认知障碍临床分析[J].河北联合大学学报(医学版),2013,1:198-201.
[5]朱卫锋.肺性脑病与动脉血气关系临床分析[J].临床肺科杂志,2012,6:123-145.
[6]孙琼.老年人肺性脑病的诱因分析及护理对策[J].当代护士(下旬刊),2012,4:96-98.
[7]刘继权,俞兴群.中医药治疗AECOPD呼吸衰竭的研究现状[J].中医药临床杂志,2014,9:252-261.
[8]袁顺蓉,邓旭,陶冠宇,等.有创无创序贯机械通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床研究[J].西部医学,2014,9:1245-1251.
[9]谢东,卢国良.中西医结合治疗慢性阻塞性肺疾病并呼吸衰竭临床研究[J].四川中医,2014,9:301-308.