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目的观察无创正压通气(NIPPV)合用尼可刹米治疗Ⅱ型呼吸衰竭合并神志障碍(肺性脑病)的治疗效果。方法 97例慢性阻塞性肺疾病急性加重(AECOPD)合并肺性脑病患者随机分为治疗组(49例)和对照组(48例)。两组均给予抗感染、平喘、祛痰等常规治疗。治疗组给予NIPPV合用尼可刹米静脉滴注,对照组予NIPPV。观察两组治疗前及治疗后2、24、48和96h时pH值、PaO2、PaCO2值,意识转清时间及临床症状变化情况。结果治疗组与对照组比较,在治疗后24h时pH值、PaCO2较对照组改善(P<0.05),而在2、48、96h时均无统计学差异;在治疗后2、24、48、96h时两组PaO2均无统计学差异。在意识转清时间上,治疗组在24、48h内好于对照组(P<0.05)。结论 NIPPV合用尼可刹米治疗AECOPD合并肺性脑病能在短期内纠正低氧血症和高碳酸血症,明显改善意识状态。
Objective To observe the therapeutic effect of NIPPV combined with nikethamide on type Ⅱ respiratory failure complicated with psychiatric disorders (pulmonary encephalopathy). Methods A total of 97 patients with acute obstructive pulmonary disease (AECOPD) complicated with pulmonary encephalopathy were randomly divided into treatment group (49 cases) and control group (48 cases). Both groups were given anti-infection, asthma, expectorant and other conventional treatment. The treatment group was given NIPPV combined with Nicorandil intravenous infusion, the control group was NIPPV. The changes of pH value, PaO2, PaCO2, time of consciousness clearing and clinical symptoms before treatment and at 2, 24, 48 and 96 hours after treatment were observed. Results Compared with the control group, the PaCO2 in the treatment group was significantly improved at 24 hours after treatment (P <0.05), but no significant difference at 2,48,96 hours (P> 0.05). After 2, 24, 48, 96h PaO2 no significant difference between the two groups. In conscious time to clear the treatment group within 24,48h better than the control group (P <0.05). Conclusion NIPPV combined with nikethamide in the treatment of AECOPD with pulmonary encephalopathy can correct hypoxemia and hypercapnia in a short period of time, and significantly improve the state of consciousness.