苗润丰,方蕾,刘大禹
MIAO Runfeng,FANG Lei,LIU Dayu

• 1:扬州大学附属医院急诊科
• 2:扬州大学
• 3:中日联谊医院

摘要(Abstract)：

目的:探讨无创正压通气联合尼可刹米治疗急性加重期慢性阻塞性肺疾病(AECOPD)并Ⅱ型呼吸衰竭的效果。方法:将110例AECOPD并Ⅱ型呼吸衰竭患者均分为治疗者和对照组,两组均实施常规祛痰、平喘、抗感染等治疗;在常规治疗基础上,对照组患者实施无创正压通气,治疗组采取无创正压通气联合呼吸兴奋剂尼可刹米治疗;观察两组治疗前后的血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、p H值,记录两组患者治疗前及治疗7 d时的第1 s用力呼气容积占预计值百分比(FEV1%)、呼吸频率及呼吸困难指数(m MRC),对比两组患者的气管插管情况、平均住院天数和治疗效果。结果:治疗组治疗后4、24、48 h的PaCO_2值显著低于对照组,差异有统计学意义(P<0.05);治疗组治疗7 d时的呼吸频率及m MRC均显著低于对照组,差异有统计学意义(P<0.05);治疗组的气管插管率为7.27%,明显低于对照组的18.18%;治疗组患者的平均住院时间比对照组短,差异有统计学意义(P<0.05);治疗组患者的治疗总有效率为90.91%,对照组为76.36%,组间比较,差异有统计学意义(P<0.05)。结论:无创正压通气联合尼可刹米治疗AECOPD合并Ⅱ型呼吸衰竭,可有效改善患者的动脉血气指标,临床疗效显著。
Objective: To investigate the effect of noninvasive positive pressure ventilation combined with nikethamide in the treatment of AECOPD( acute exacerbation of chronic obstructive pulmonary disease) with typeⅡrespiratory failure. Method: 110 cases of AECOPD with typeⅡ respiratory failure patients were randomly divided into two groups. All patients were given conventional expectorant,antiasthma and anti-infection treatment. On the basis of routine treatment,control group patients accepted noninvasive positive pressure ventilation,and the treatment group patients were given noninvasive positive pressure ventilation and nikethamide. PaO_2,PaCO_2 and p H value were observed before and after treatment in the two groups. FEV1%,respiratory rate and m MRC were detected before treatment and 7 d after treatment in the two groups. Tracheal intubation condition,average hospital stay and curative effect were compared between the two groups. Results: The PaCO_2 value of the treatment group was significantly lower than that of the control group at 4 h,24 h and 48 h after treatment( P < 0. 05).The respiratory rate and m MRC in the treatment group were significantly lower than those in the control group in 7 days after treatment( P < 0. 05). The rate of tracheal intubation was 7. 27% in the treatment group,which was significantly lower than that in the control group( 18. 18%). The average hospital stay in the treatment group was shorter than control group( P < 0. 05). The total effective rate was90. 91% in the treatment group and 76. 36% in the control group,there was significant difference between the two groups( P < 0. 05). Conclusion: Nikethamide combine with noninvasive positive pressure ventilation in the treatment of AECOPD with typeⅡrespiratory failure can effectively improve the arterial blood gas index,clinical efficacy is remarkable.

关键词(KeyWords)： Ⅱ型呼吸衰竭;急性加重期慢性阻塞性肺疾病;尼可刹米;无创正压通气
typeⅡ respiratory failure;acute exacerbation of chronic obstructive pulmonary disease;nikethamide;noninvasive positive pressure ventilation

Abstract:

Keywords:

基金项目(Foundation): 2016江苏省高校自然科学面上项目(16KJB35000616)

作者(Author): 苗润丰,方蕾,刘大禹
MIAO Runfeng,FANG Lei,LIU Dayu

DOI: 10.19367/j.cnki.1000-2707.2017.10.018

参考文献(References)：

• [1]冯涛.无创正压通气治疗老年慢性阻塞性肺病急性加重期合并呼吸衰竭失败的相关因素[J].中国老年学杂志,2012(22):5031-5032.
• [2]谭伟,孙龙凤,代冰,等.慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者使用无创正压通气成功的临床预测因素研究[J].中国全科医学,2013(2):147-150.
• [3]中华中医药学会.慢性阻塞性肺疾病诊疗指南[J].中国中医药现代远程教育,2011(12):115-116.
• [4]付会文,许运铎,孙涛,等.无创正压通气对AECOPD合并肺心病患者血气分析、血浆高敏C反应蛋白和N-末端脑钠肽前体的影响[J].疑难病杂志,2014(6):590-591,596.
• [5]杨欢欢,刘荣玉.无创正压通气治疗AECOPD合并Ⅱ型呼吸衰竭的临床疗效观察[J].安徽医学,2012(2):186-188.
• [6]Pazarli,Ahmet C,Koseoglu,Handan I,et al.Procalcitonin:Is it a predictor of noninvasive positive pressure ventilation necessity in acute chronic obstructive pulmonary disease exacerbation[J].Journal of research in medical sciences,2012(11):1047-1051.
• [7]刘艳秀,瞿长春,刘俏敏,等.Bi PAP呼吸机联合呼吸兴奋剂治疗AECOPD并肺性脑病的应用研究[J].国际医药卫生导报,2013(24):3700-3702.
• [8]Fan,LP,Zhao QH,Liu YC,et al.Semiquantitative cough strength score and associated outcomes in noninvasive positive pressure ventilation patients with acute exacerbation of chronic obstructive pulmonary disease[J].Respiratory medicine,2014(12):1801-1807.
• [9]戴山林,金宇.无创正压通气复合尼可刹米治疗Ⅱ型呼吸衰竭合并神志障碍的疗效[J].江苏医药,2013(22):2741-2742.
• [10]文申英,王小军,廖涛,等.尼可刹米与纳洛酮联合无创正压通气治疗AECOPD并发呼吸衰竭[J].现代生物医学进展,2016(31):6110-6113.

文章评论(Comment)：