尼可刹米及面（鼻）罩吸氧对高原慢性肺心病呼衰患者的疗效观察

OBSERVATION OF ACPHDPPF TREATED BY NIKETHAMIDI AND BIPAP ACCESSORY RESPIRATORY DEPARTMENT

本文报道高原低氧寒冷特殊环境下，２０例慢性肺心病Ⅱ型呼衰患者应用呼吸兴奋剂尼可刹米并用面（鼻）罩支持人工通气的临床疗效。慢性肺心病伴ＣＯ＿２潴留时，尼可刹米可兴奋呼吸中枢，提高通气量，呼吸形态变浅速而通气效率改善不够理想，加至慢性肺心病患者气道阻力高、ＰａＣＯ＿２下降趋势缓慢，并用面（鼻）罩无创性人工通气，可克服慢阻肺患者气道阻力高的特点。采用自主呼吸模式（Ｓ模式）、逐渐增大吸气相正压１．５６９～１．９６１ｋＰａ，使患者容易适应和合作，减慢呼吸频率、减慢心率、减轻呼吸肌肉作功。压力支持通气显著的改善了尼可刹米兴奋中枢的浅速呼吸、通气效率差的弊端。补偿了高原慢性肺心病患者保持较高的中枢驱动性和对低氧通气的反应性，以发挥吸氧及药物的积极作用。

his paper reported the clinical effect of nikethamidi and bipap accesory on 20 altitude chron-ic pulmonary heart disease patients with pulmonary failure(ACPHDPPF) under altitude hypoxicand cold environment. Although nikethamidi alone stimulated respiratory centre and enhancedventilation,the drop of PaCO_2 was slow and the improvement was not satisfactory because of thehigh airway resistance in the patients with CO_2 retention.The bipap accesory was used at auto-breathe model(S model)and the inspiratory positive pressure increased up to 1. 569～1. 961kPagradually. The treatment slowed down respiratory frequency,heart rate , reduced the musclemovement and then improved the disadvantage of nikethamidi used alone. It kept the patients athigh centre dirving and sensitive response to hypoxia and showed cooperative effects of drug andoxygen inhalation.