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目的 评价鼻面罩无创正压通气联用呼吸兴奋剂治疗慢阻肺呼吸衰竭合并肺性脑病患者的疗效。方法 将 2 0 0 1- 6～ 2 0 0 3- 12广东省人民医院收治的 4 2例慢阻肺呼吸衰竭合并肺性脑病患者随机分为治疗组和对照组 ,治疗组采用呼吸兴奋剂、鼻面罩无创正压通气及常规治疗 ;对照组采用鼻面罩无创正压通气和常规治疗。通气前、通气 3h及通气结束病情稳定后复查动脉血气分析。结果 治疗组 16例患者中 14例治疗成功 ,另外 2例病情加重需气管插管机械通气治疗 ;对照组 2 6例患者中 14例治疗成功 ,12例需气管插管机械通气治疗。治疗组气管插管率明显低于对照组 (P =0 . 0 2 5 ) ,人机同步性明显高于对照组 (P =0 . 0 0 4 )。治疗组 14例治疗成功患者鼻面罩无创正压通气治疗前为pH 7. 2 7± 0 . 0 4、PaCO2 为 (85± 10 )mmHg (1mmHg =0. 133kPa)、PaO2 为 (6 .3± 15 )mmHg ,在平均无创通气治疗 10d后pH为 7 .39± 0. 0 5 (P <0 . 0 1)、PaCO2 为 (6. 2± 8)mmHg(P <0 .0 5 )、PaO2 为 (77±13)mmHg(P >0. 0 5 )。结论 无创正压通气联用呼吸兴奋剂治疗慢阻肺呼吸衰竭合并肺性脑病患者可以改善患者的人机同步性 ,提高无创正压通气的疗效 ,减少患者的气管插管率 ;但对于气道分泌物粘绸不易咳出的患者 ,则应尽
Objective To evaluate the efficacy of nasal mask non-invasive positive pressure ventilation combined with respiratory stimulant in the treatment of COPD patients with pulmonary encephalopathy. Methods Forty-two patients with COPD with pulmonary encephalopathy admitted to Guangdong Provincial People’s Hospital from 2001 to 2006 were randomly divided into treatment group and control group. The treatment group was treated with respiratory stimulant, Nasal mask noninvasive positive pressure ventilation and conventional treatment; control group nasal mask noninvasive positive pressure ventilation and conventional treatment. Ventilation, Ventilation 3h and Ventilation at the end of stable condition after the review of arterial blood gas analysis. Results In the treatment group, 14 of the 16 patients were successfully treated and the other 2 patients were experiencing endotracheal intubation mechanical ventilation. In the control group, 14 of 26 patients were successfully treated, and 12 patients needed mechanical ventilation of tracheal intubation. The tracheal intubation rate in the treatment group was significantly lower than that in the control group (P = .025), and the synchronicity was significantly higher in the treatment group than in the control group (P = .040). The treatment group 14 patients successfully treated nasal mask noninvasive positive pressure ventilation before treatment for pH7.27 ± 0.4, PaCO2 (85 ± 10) mmHg (1mmHg = 0.133kPa), PaO2 was (6.3 ± 15) mmHg, the average pH was 7.39 ± 0. 05 (P <0.01), PaCO2 was (6.2 ± 8) mmHg (P <0.05), PaO2 (77 ± 13) mmHg (P> 0.05). Conclusion Non-invasive positive pressure ventilation combined with respiratory stimulants in patients with COPD and pulmonary encephalopathy can improve the human-machine synchronization and improve the curative effect of noninvasive positive pressure ventilation and reduce the rate of tracheal intubation. However, Sticky silk secretions difficult to cough patients, you should do