慢性阻塞性肺病急性加重期合并肺性脑病患者的疗效观察

摘要

Objective:To discuss the efficacy of bi-level positive airway pressure ventilation (BiPAP)and nal-oxone for the treatment of chronic obstructive pulmonary disease (COPD) in acute exacerbation combined with pulmonary encephalopathy. Methods:Sixy-six cases with COPD in acute exacerbation combined pulmonary encephalopathy were divided into two groups. 33 cases in control group were treated with oxygen inhalation, anti-infection and so on ;33 cases treated with BiPAP combined with naloxone on the basis of conventional treatment, naloxone 0.8mg intravenous injection for the first time,and then 3ug/kg·h by micro pump continous injection. PH, PaO2, PaCO2 and SaO2 before and after treat-ment in two groups were compared, and the change of HR, RR, MAP and clinical symptoms were observed. The hospitalization time, intubation rate and mortality rate were also observed.Results:After treatment, HR, RR and blood pressure were obviously improved in two groups.Whereas PaO2 and SaO2 were obviously increased in control group in 3h (P<0.05).But pH and PaCO2 were not obviously changed (P>0.05),some cases even worse; PaO2 and SaO2 were maintained at a high level in 24h, pH and PaCO2 were not obviously improved. The improvement of each index in observation group was obviously higher than that in control group after treatment, the difference had statistical significance(P<0.05). Compared with control group, observation group had shorter hospitalization time, lower intubation rate and mortality rate. The difference was obvious and had statistical significance(P<0.05). Conclusion:The treatment of COPD combined with pulmonary encephalopathy by BiPAP and naloxone has obvious cura-tive effect. It can obviously decrease the intubation rate and mortality rate.%目的：观察无创双水平气道正压（BiPAP）通气联合纳洛酮（NLX）在慢性阻塞性肺病（COPD）急性加重期合并肺性脑病治疗中的应用。方法：选取66例COPD急性加重期合并肺性脑病患者分为两组，对照组采用吸氧、抗感染、化痰平喘常规综合治疗，观察组在此基础上使用纳洛酮首次0.8mg静脉注射，随后予3μg/（kg·h）微量泵持续静脉泵入，并持续使用BiPAP通气，观察两组疗效。结果：两组治疗后心率、呼吸频率、血压均有显著改善（P<0.05）。对照组治疗3h后PaO2和SaO2增加（P<0.05），但pH值和PaCO2均无明显改变（P均>0.05），部分患者甚至加重；24h时PaO2维持在较高水平，pH值和PaCO2改善仍不明显。与对照组比较，观察组治疗后各项指标均恢复正常（P<0.05）。观察组诊治时间短、气管插管率降低、病死率明显下降，这些数据与对照组相比，差异均具有统计学意义（P<0.05）。结论：BiPAP通气联用NLX治疗COPD急性加重期合并肺性脑病的临床效果较好，插管率、病死率明显降低。