呼吸兴奋剂联合无创正压通气治疗COPD并Ⅱ型呼吸衰竭  

Application of respiratory stimulant combined with non-invasive positive pressure ventilation in type Ⅱ respiratory failure complicated with chronic obstructive pulmonary disease

作　　者：李军[1] 许玲华[1] 李萍[1] 

机构地区：[1]东南大学医学院附属徐州医院呼吸科,江苏徐州221009

出　　处：《徐州医学院学报》2009年第9期586-588,共3页Acta Academiae Medicinae Xuzhou

摘　　要：目的观察呼吸兴奋剂联合无创正压通气治疗慢性阻塞性肺疾病(COPD)急性加重并Ⅱ型呼吸衰竭的疗效。方法将48例COPD急性加重并Ⅱ型呼吸衰竭患者随机分成A、B、C 3组,每组均给予抗感染、支气管扩张剂、氧疗、营养支持治疗等。在此基础上,A组给予尼可刹米静脉滴注;B组给予经鼻或口鼻面罩双水平气道正压通气(BiPAP)呼吸机正压通气,C组在BiPAP呼吸机正压通气的同时静滴尼可刹米,疗程5天,观察治疗前后患者的血气分析、呼吸频率、潮气量和分钟通气量。结果B、C两组治疗后患者的血气分析较治疗前明显改善,其中C组治疗后PaCO2的下降较B组明显。C组治疗后的分钟通气量大于B组。结论呼吸兴奋剂联合无创正压通气治疗能显著改善COPD患者的呼吸衰竭,增加通气量,尤其在改善高碳酸血症方面,疗效优于单纯无创正压通气治疗。Objective To observe the effects of respiratory stimulant combined with non - invasive positive pressure ventilation （NPPV） on type II respiratory failure complicated with acute exacerbations of chronic obstructive pulmonary disease （COPD）. Methods 48 patients with type Ⅱ respiratory failure complicated by acute exacerbations of COPD were randomly assigned to groups A, B and C. Patients in each group were treated with antibiotics, bronehodilators, oxygen therapy and allowance of nutrients. Subsequently, the patients in group A received intravenous drip of nikethamide, those in group B were allowed ventilation through the nose or a oro -nasal mask connected to a bi-level positive airway pressure （BiPAP） ventilator and the--patients in group C underwent ventilation with a BiPAP ventilator coupled with intravenous dripping of nikethamide. All patients were treated for 5 days and their arterial blood gas measurements, respiratory frequencies, tidal volumes and minute ventilation volumes of patients before and after treatment were observed. Results After the treatment, the arterial blood gas measurements of B and C group were obviously improved, the carbon dioxide partial pressure （ PaCO2 ） in group C were more evident than that in B group, and the minute ventilation volumes in group C were greater than those in group B. Conclusion The treatment with respiratory stimulant combined with NPPV could significantly improve respiratory failure of COPD patients and increase their minute ventilation volume, and for the correction of hypercapnia in particular, it has better effect than NPPV.

关 键 词：呼吸兴奋剂 无创正压通气 慢性阻塞性肺疾病 呼吸衰竭 

分 类 号：R563.3[医药卫生—呼吸系统]