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目的探讨双水平气道正压通气(BiPAP)联合泵入呼吸兴奋剂治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效。方法选取2012年10月—2013年5月九江学院附属医院呼吸内科收治的COPD合并Ⅱ型呼吸衰竭患者45例,将其随机分为A、B、C 3组,各15例。A组患者给予微量泵泵入尼可刹米,B组患者给予BiPAP呼吸机治疗,C组患者给予BiPAP联合泵入尼可刹米治疗,均连续治疗72 h。判定临床疗效并比较治疗前、治疗12 h及治疗72 h后3组患者心率(HR)、呼吸频率(RR)及动脉血气分析指标(PaO2和PaCO2)。结果 A组患者总有效率为66.7%,B组为73.3%,C组为93.3%。C组患者总有效率高于A组和B组(P<0.05);A组和B组患者总有效率比较,差异无统计学意义(P>0.05)。治疗前3组患者HR、RR、PaO2及PaCO2比较,差异无统计学意义(P>0.05);治疗12 h和72 h后C组患者HR、RR及PaCO2低于A组和B组,PaO2高于A组和B组(P<0.05);治疗12h和72 h后A组和B组患者HR、RR、PaO2及PaCO2比较,差异无统计学意义(P>0.05)。结论 Bi PAP联合泵入呼吸兴奋剂治疗COPD合并Ⅱ型呼吸衰竭疗效较好,能有效改善患者的临床症状及血气分析指标。
Objective To investigate the clinical effects of bi-level positive airway pressure (BiPAP) combined with pumped into the respiratory stimulant in the treatment of chronic obstructive pulmonary disease (COPD) with type Ⅱ respiratory failure. Methods Forty-five COPD patients with type Ⅱ respiratory failure admitted to Department of Respiratory Medicine, Jiujiang University Hospital from October 2012 to May 2013 were randomly divided into A, B and C groups, 15 cases each. Patients in group A were treated with micropump pump with nikethamide, patients in group B were treated with BiPAP ventilator, and patients in group C were treated with BiPAP and nikethamide, all of which were treated continuously for 72 hours. The clinical efficacy was evaluated and the heart rate (HR), respiratory rate (RR) and arterial blood gas analysis indexes (PaO2 and PaCO2) were compared between before treatment, 12 h and 72 h after treatment. Results The total effective rate in group A was 66.7%, in group B 73.3% and in group C 93.3%. The total effective rate in group C was higher than that in group A and B (P <0.05). There was no significant difference in the total effective rate between group A and group B (P> 0.05). There was no significant difference in HR, RR, PaO2 and PaCO2 between the three groups before treatment (P> 0.05). HR, RR and PaCO2 in group C were lower than those in group A and B after 12 and 72 hours There was no significant difference in HR, RR, PaO2 and PaCO2 between group A and group B (P <0.05) after 12 and 72 hours of treatment. Conclusion Bi PAP combined with pumped into the respiratory stimulant treatment of COPD with type Ⅱ respiratory failure better curative effect can effectively improve the clinical symptoms and blood gas analysis indicators.