尼可刹米对老年呼吸衰竭患者动脉血气的影响（附41例分析）

The effect of nikethamide on arterial blood gas in elderly patients with respiratory failure:analysis of 41 cases

目的应用呼吸兴奋剂治疗慢性阻塞性肺病（ＣＯＰＤ）所致呼吸衰竭（以下简称呼衰）是有争论的。本研究使用尼可刹米治疗老年人呼衰，评估呼吸兴奋剂对呼衰患者动脉血气的影响。方法对４１例（６３例次）老年ＣＯＰＤⅡ型呼衰患者应用尼可刹米（３．７５ｇ）持续静脉点滴４小时，分析患者治疗前、给药后２、４小时的动脉血气；其中１１例次观察了连续８小时以上静脉点滴尼可刹米的动脉血气变化。结果６３例次中，ＰａＣＯ２与给药前比较：（１）给药２小时下降，给药结束３０分钟内继续下降１２例次（１９％），上升２１例次（３３％）；（２）给药２小时上升，给药结束３０分钟内下降５例次（８％），继续升高２５例次（４０％）。１１例次连续８小时以上静脉点滴尼可刹米，显示ＰａＣＯ２呈下降后又反跳的变化趋势；８小时内观察，反跳的发生率与持续给药时间的长短呈正相关（ｒ＝０．９８２，Ｐ值＜０．００１）。

Objective There is dispute about the effect of central respiratory stimulant in treating COPD patients with respiratory failure.In this study nikethamide was administered to aged patients with respiratory failure and its effect on arterial blood gas was evaluated.Methods Forty-one cases(63 case-times) of aged COPD type Ⅱ respiratory failure patients were treated with nikethamide(3.75g) by means of constant intravenous drip for 4 hours,and the arterial blood gases of patients before treatment,at 2 hours and 4 hours administration were analyzed.Among them 11 case-times were on the intravenous drip of nikethamide for 8 successive hours.Results Among 63 case-times,compared with that before administration:(1) PaCO2 in 12 case-times(19%) decreased at 2 hours and 4 hours;PaCO2 in 21 case-times(33%) decreased at 2 hours then increased again at 4 hours;(2) PaCO2 in 5 case-times(8%) increased at 2 hours and then decreased again at 4 hours;PaCO2 in 25 case-times(40%) increased both in 2 hours and 4 hours.Eleven case-times,in which the intravenous drip of nikethamide were applied continuously for 8 hours,showed that PaCO2 had the tendency of being decreased and then increased.The observation within 8 hours showed that the rebounding rate was positively related to the duration of the continuous intravenous drip(r=0.982,P<0.001).Conclusious It is not so effective for nikethamide by intravenous drip to improve the arterial blood gas of aged patients with respiratory failure.