目的 探讨慢性阻塞性肺疾病(COPD)患者行机械通气时应用小剂量甲状腺素的临床疗效.方法 COPD合并Ⅱ型呼吸衰竭行机械通气患者67例,随机分为常规治疗组(A组)32例和在常规治疗基础上加用小剂量甲状腺素组(B组)35例,观察2组血清甲状腺素(T3、T4、TSH)水平及心率、血气(PaO2、PaCO2)变化,记录撤机成功率和机械通气时间.结果 B组治疗后3 d时T3、T4水平较治疗前明显提高,PaO2、PaCO2明显改善,差异有统计学意义(P均<0.05),5 d左右达正常范围;TSH、心率无明显变化(P均>0.05).A组治疗后各时点T3、T4、TSH水平及心率、PaO2、PaCO2变化较治疗前无明显差异(P均>0.05).B组治疗后各时点T3、T4、心率、PaO2、PaCO2与A组比较差异有统计学意义(P均<0.05),B组撤机成功率及机械通气时间均优于A组(P<0.05).结论 COPD患者行机械通气时应用小剂量甲状腺素可明显提高治疗效果.%Objective To investigate the therapeutic effect of low-dose thyroxin in chronic obstructive pulmonary dis-ease( COPD ) with mechanical ventilation. Methods Sixty-seven patients who suffered from chronic obstructive pulmonary disease combined with respiratory failure and treated with mechanical ventilation were randomized allocated into conventional treatment group ( group A, n = 32 ) and thyroxin group ( group B, n = 35 ) which with additional oral thyroxin at the daily dose of 20 mg. The levels of T3 ,T4 and TSH in serum and the average changes of their heart rates,PaO2 and PaCO2 were recorded. Weaning succeed rate and the time of mechanical ventilation were observed and compared. Results The levels of T3 and T4 in group B increased obviously after treatment within 3 days, and PaO2 and PaCO2 were improved significantly( P < 0. 05 ), these levels improved to normal range at 5th day. The levels of TSH and heart rate didn't change obviously( P > 0.05 ). Compared with group A, the levels of T3, T4 , heart rate, PaO2 and PaCO2 in group B were improved significantly at all-time points ( P <0.05 ), while these levels did not change obviously in group A after treatment (P >0. 05 ). The weaning succeed rate in group B were better than group A, and the time of mechanical ventilation in group B were obviously shorter than group A ( P < 0. 05 ). Conclusion Low dose thyroxin is safe and can improve therapeutic effect significantly in chronic obstructive pulmonary disease with mechanical ventilation.
展开▼
