多沙普仑对比尼可刹米治疗COPD合并呼吸衰竭患者临床疗效  

Effect of doxapram versus nikzami in patients with COPD complicated with respiratory failure

作　　者：严鹏[1] 李欣 齐连振 代兆华 YAN Peng;LI Xin;QI Lian-zhen;DAI Zhao-hua(Department of Medical,the Second Affiliated Hospital of Xingtai Medical College,054000 Xingtai,Hebei,China;Department of Critical Care Medicine,the Second Affiliated Hospital of Xingtai Medical College,054000 Xingtai,Hebei,China)

机构地区：[1]邢台医学高等专科学校第二附属医院医务科,邢台054000 [2]邢台医学高等专科学校第二附属医院重症医学科,邢台054000

出　　处：《东南国防医药》2021年第6期582-587,共6页Military Medical Journal of Southeast China

基　　金：河北省邢台市科技计划项目(2019ZC341)。

摘　　要：目的观察多沙普仑、尼可刹米不同呼吸兴奋剂治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者疗效及其对肺表面活性蛋白(SP-D)和Clara细胞分泌蛋白(CC16)表达情况的影响。方法选取2016年12月-2017年12月邢台医学高等专科学校第二附属医院收治的194例COPD合并呼吸衰竭患者,采用随机数字表法将患者分为多沙普仑组和尼可刹米组,每组97例;在常规治疗的基础上,尼可刹米组患者给予尼可刹米静脉滴注;而多沙普仑组给予多沙普仑静脉滴注。治疗一个疗程后对患者疗效进行评估,比较治疗前后患者血气分析指标、6 min步行试验结果和生活质量,检测治疗前后血清中SP-D与CC16含量,记录2组不良反应情况。结果多沙普仑组总有效率(94.84%)明显高于尼可刹米组(75.25%),差异有统计学意义(P<0.05)。治疗后2组患者PaO_(2)、OI升高,PaCO_(2)降低,多沙普仑组PaO_(2)、OI显著高于尼可刹米组[(83.61±7.34)mmHg vs(72.65±6.85)mmHg,(298.67±21.34)mmHg vs(262.41±26.64)mmHg,P<0.01],PaCO_(2)显著低于尼可刹米组[(51.03±5.71)mmHg vs(35.10±6.22)mmHg,P<0.01]。多沙普仑组患者出院后3、6个月6 min步行距离高于尼可刹米组患者(P<0.05)。多沙普仑组出院后3、6个月生活质量优于尼可刹米组(P<0.05)。治疗1个疗程后2组患者血清SP-D降低、CC16升高,并且多沙普仑组SP-D低于尼可刹米组[(0.52±0.09)ng/mL vs(0.64±0.07)ng/mL,P<0.01],而CC16水平高于尼可刹米组[(0.21±0.05)pg/mL vs(0.28±0.04)pg/mL,P<0.01]。多沙普仑组出院91例,尼可刹米组出院71例。多沙普仑组改有创通气率较尼可刹米组明显降低(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论多沙普仑较尼可刹米治疗COPD合并呼吸衰竭患者临床疗效更加明确,能够有效改善PaO_(2)、PaCO_(2),提高患者远期生活质量,同时降低SP-D水平,提高CCL16表达水平,安全可靠,具有一定临床应用价值。Objective To observe the effect of doxapron-assisted treatment of Chronic obstructive pulmonary disease(COPD)patients with respiratory failure and its effect on the expression of surfactant protein D(SP-D)and Clara cell secretory 16-kd protein(CC16).Methods 194 patients with COPD and respiratory failure admitted to our hospital from December 2016 to December 2017 were enrolled.Patients were divided into doxapram group and nikethamide group On the basis of conventional treatment,the nikethamide group received an intravenous infusion of nikethamide,while doxapram group was given intravenous infusion of doxapram,and 7 days was a course of treatment.After one course of treatment,the efficacy of the patients was evaluated,and the blood gas analysis index of the patients before and after treatment,the results of the 6 min walking test and the quality of life was compared.The contents of sp-d and CC16 in the serum before and after treatment were observed.Adverse reactions were recorded in both groups.Results The total effective rate of doxapram group(94.84%)was significantly higher than that of nicothamide group(75.25%)(P<0.05).After treatment,PaO_(2) and OI increased and PaCO_(2) decreased in the two groups.PaO_(2) and OI in doxapram group were significantly higher than those in nicothamide group[(83.61±7.34)mmHg vs(72.65±6.85)mmHg,(298.67±21.34)mmHg vs(262.41±26.64)mmHg,P<0.01],and PaCO_(2) was significantly lower than those in nicothamide group[(51.03±5.71)mmHg vs(35.10±6.22)mmHg,P<0.01].The 6-min walking distance in doxapram group was higher than that in nicothamide group at 3 and 6 months after discharge(P<0.05).The quality of life in doxapram group was better than that in nicothamide group at 3 and 6 months after discharge(P<0.05).After one course of treatment,serum SP-D decreased and CC16 increased in the two groups.SP-D in doxapram group was lower than that in nicothamide group[(0.52±0.09)ng/mL vs(0.64±0.07)ng/mL,P<0.01],while the level of CC16 was higher than that in nicothamide group[(0.21±0.05)pg/mL

关 键 词：多沙普仑 尼可刹米 慢性阻塞性肺疾病合并呼吸衰竭 表面活性蛋白 CLARA细胞分泌蛋白 

分 类 号：R453.2[医药卫生—治疗学]