多沙普仑联合双水平气道正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的临床疗效

摘要

目的 观察多沙普仑联合双水平气道正压通气(BiPAP)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者的临床疗效.方法 选取2013年1月—2017年1月南充市仪陇县人民医院呼吸内科收治的AECOPD合并Ⅱ型呼吸衰竭患者100例,根据治疗方法分为对照组与观察组,每组50例.对照组患者行BiPAP治疗,观察组患者在对照组基础上加用多沙普仑治疗;两组患者均治疗6 d.比较两组患者临床疗效,治疗前后动脉血气分析指标、呼吸频率、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)、心率及血清克拉拉细胞蛋白(CC16)、表面活性蛋白D(SP-D)水平,并观察两组患者治疗期间死亡、不良反应情况.结果 观察组患者临床疗效优于对照组(P<0.05).治疗前两组患者血氧饱和度(SpO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、pH值比较,差异无统计学意义(P>0.05);治疗后观察组患者SpO2、PaO2、pH值高于对照组,PaCO2低于对照组(P<0.05).治疗前两组患者呼吸频率、FEV1/FVC、心率比较,差异无统计学意义(P>0.05);治疗后观察组患者呼吸频率、心率低于对照组,FEV1/FVC高于对照组(P<0.05).治疗前两组患者血清CC16、SP-D水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血清CC16水平高于对照组,血清SP-D水平低于对照组(P<0.05).观察组患者治疗期间病死率低于对照组(P<0.05),而两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05).结论 多沙普仑联合BiPAP治疗AECOPD合并Ⅱ型呼吸衰竭的临床疗效确切,可有效改善患者动脉血气分析指标、呼吸功能、心率及肺功能,缓解患者肺部炎症,降低患者病死率,且安全性较高.%Objective To observe the clinical effect of doxapram combined with bi-level positive airway pressure (BiPAP) ventilation in treating AECOPD patients complicated with typeⅡ respiratory failure.Methods From January 2013 to January 2017,a total of 100 AECOPD patients complicated with typeⅡ respiratory failure were selected in the Department of Respiratory Medicine,the People's Hospital of Yilong County,Nanchong,and they were divided into control group and observation group,each of 50 cases.Patients in control group received BiPAP ventilation,while patients in observation group received doxapram combined with BiPAP ventilation;both groups continuously treated for 6 days.Clinical effect,arterial blood-gas analysis index,respiratory rate,FEV1/FVC,heart rate,serum levels of CC16 and SP-D before and after treatment were compared between the two groups,incidence of death and adverse reactions was observed during the treatment.Results Clinical effect in observation group was statistically significantly better than that in control group(P<0.05) .No statistically significant differences of SpO2,PaCO2,PaO2or pH was found between the two groups before treatment(P>0.05);after treatment, SpO2,PaO2and pH in observation group were statistically significantly higher than those in control group,while PaCO2in observation group was statistically significantly lower than that in control group(P<0.05) .No statistically significant differences of respiratory rate,FEV1/FVC or heart rate was found between the two groups before treatment(P>0.05);after treatment, respiratory rate and heart rate in observation group were statistically significantly lower than those in control group,while FEV1/FVC in observation group was statistically significantly higher than that in control group(P<0.05) .No statistically significant differences of serum levels of CC16 or SP-D was found between the two groups before treatment(P>0.05);after treatment, serum CC16 level in observation group was statistically significantly higher than that in control group,while serum SP-D level in observation group was statistically significantly lower than that in control group(P<0.05) .Fatality rate in observation group was statistically significantly lower than that in control group(P<0.05),while no statistically significant differences of incidence of adverse reactions was found between the two groups(P>0.05) .Conclusion Doxapram combined with bi-level positive airway pressure(BiPAP) ventilation has certain clinical effect in treating AECOPD patients complicated with type Ⅱ respiratory failure,can effectively adjust the arterial blood-gas analysis index,improve the respiratory function and pulmonary function, reduce the heart rate and fatality rate,relieve the pulmonary inflammation,with relatively high safety.