BiPAP通气联合呼吸兴奋剂治疗慢性阻塞性肺疾病合并肺性脑病临床研究.docVIP

BiPAP通气联合呼吸兴奋剂治疗慢性阻塞性肺疾病合并肺性脑病临床研究 　　[摘要] 目的：探讨无创双水平呼吸道正压通气（Bi-level positive airway pressure，BiPAP）联合呼吸兴奋剂+醒脑静治疗慢性阻塞性肺疾病（COPD）合并肺性脑病的临床疗效。方法：将66例COPD合并肺性脑病患者随机分成三组，每组各22例，在BiPAP基础上分别联合纳洛酮+尼可刹米+醒脑静治疗、纳洛酮+醒脑静治疗和纳洛酮治疗，比较三种治疗方法的临床疗效。结果：BiPAP联合呼吸兴奋剂（纳洛酮+尼可刹米）+醒脑静有效率为90.9%，并且在症状改善时间及动脉血气分析结果显著好于其他两组（P0.05）。结论：BiPAP与呼吸兴奋剂及醒脑静联用，效果明显，值得临床推广应用。 　　[关键词] 无创双水平呼吸道正压通气；慢性阻塞性肺疾病；肺性脑病；呼吸兴奋剂；醒脑静 　　[中图分类号] R563 [文献标识码] Ａ [文章编号] 1673-7210（2012）01（a）-039-02 　　 　　Clinical study on BiPAP combined with respiratory stimulant in the treatment of patients with pulmonary encephalopathy and COPD 　　LI Yanjie 　　Department of Internal, Features Hospital of Daqing Oilfield General Hospital Group, Heilongjiang Province, Daqing 163416, China 　　[Abstract] Objective: To evaluate the effect of BiPAP combined with respiratory stimulant and Xingnaojing in the treatment of patients with pulmonary encephalopathy and COPD. Methods: 66 patients with pulmonary encephalopathy and COPD were selected to divide into three groups and each for 22 cases, patients in group A were given BiPAP plus Naloxone, Nikethamide and Xingnaojing; Group B was given BiPAP plus Naloxone and Xingnaojing; Group C was given BiPAP plus Naloxone. Clinical effects of the three methods were compared. Results: The efficient of the method which used BiPAP plus Naloxone, Nikethamide and Xingnaojing was 90.9%, and its effect of blood gas analysis was better than that of the other two groups (P0.05). Conclusion: The method of BiPAP plus respiratory stimulant and Xingnaojing has a significant effect, and it is worth to promote. 　　[Key words] BiPAP; COPD; Pulmonary encephalopathy; Respiratory stimulant; Xingnaojing 　　 　　肺性脑病是慢性阻塞性肺疾病（Chronic obstructive pulmonary diseases，COPD）急性发作的严重并发症之一，常导致患者的死亡[1]。BiPAP在治疗COPD急性加重患者的作用已经得到公认[2]，多与呼吸兴奋剂联用，亦有报道[3]称与醒脑静联用效果良好，因此本研究就BiPAP联合呼吸兴奋剂（纳洛酮+尼可刹米）+醒脑静治疗慢性阻塞性肺疾病（COPD）合并肺性脑病的临床疗效进行相关探讨。 　　1 资料与方法 　　1.1 一般资料 　　选择2008~2010年入院的COPD合并肺性脑病患者66例，其中，男42例，女24例。所有患者入院时均有不同程度的意识障碍，符合COPD合并肺性脑病的诊断标准[