BiPAP通气联合可拉明治疗慢性阻塞性肺疾病呼吸衰竭疗效研究

Efficacy of BiBAP ventilation and BiBAP ventilation combined with Coramine in treating chronic obstructive pulmonary disease with respiratory failure

目的评价双水平正压(BiPAP)通气及其联合可拉明治疗慢性阻塞性肺疾病(COPD)Ⅱ型呼吸衰竭的临床疗效。方法146例COPDⅡ型呼吸衰竭患者根据高碳酸血症的严重程度及有无意识障碍分为3组,A组60例:PaCO250～79mmHg,无肺性脑病;B组60例:PaCO2≥80mmHg,或合并轻型肺性脑病;C组26例:合并中型肺性脑病。各组再随机分为对照组及治疗组,在综合治疗基础上分别给予BiPAP通气及BiPAP通气联合可拉明治疗。观察治疗前后动脉血气指标变化、治疗无效例数、动-静脉血氧分压差(△PO2)变化。结果A、B组中治疗组及对照组动脉血气指标均显著改善(P<0.01),A组组间比较差异无显著性(P>0.05);B组中治疗组PaCO2改善程度较对照组为著(P<0.05),B组中治疗组及对照组治疗无效率分别为16.7%(5/30)、40.0%(12/30),差异有显著性(P<0.05)。C组中治疗组及对照组PaCO2均无显著改善(P>0.05),治疗无效率分别为69.2%(9/13)、76.9%(10/13),差异无显著性(P>0.05)。治疗组及对照组△PO2差异无显著性(P>0.05)。结论BiPAP通气联合可拉明治疗COPD合并严重高碳酸血症或轻型肺性脑病有较显著疗效,但对COPD合并中型肺性脑病,BiPAP通气及其联合可拉明治疗均无显著疗效。适量可拉明与BiPAP通气联用不会增加氧耗量。

Objective To compare the efficacy of BiBAP ventilation and its combination with Coramine in treating chronic obstructive pulmonary disease （COPD） complicated with respiratory failure. Methods 146 cases of COPD complicated with respiratory failure were divided into three groups according to PaCO2 and levels of consciousness disorder： group A （PaCO2 50-79mmHg,without pulmonary encephalopathy ）, group B （PaCO2 ≥80mmHg,or with mild pulmonary encephalopathy）, and group C （with moderate pulmonary encephalopathy ）. In each group, patients were enrolled in control group and ,therapy group at random, BiBAP ventilation and BiBAP ventilation combined with Coramine were given respectively. Arterial blood gases analysis, and cases of therapy failure were observed. Arteriovenous oxygen difference was also observed in some cases of A and B. Results In group A, arterial blood gases were improved greatly （P〈0.01）, but had not significant difference between control group and therapy group （P〉0.05）. In group B, PaCO2 of therapy group were improved greatly（P〈0.01）, and rates of therapy failure were 16.7%（5/30）,40.0%（12/30）in therapy group and control group respectively （P〈0.05）. In group C, PaCO2 was not im- proved greatly（P〉0.05）, and rates of therapy failure were 69.2% （9/13）,76.9% （10/13）respectively（P〉0.05）. Arteriovenous oxygen difference in therapy.group was not different greatly （P〉0.05） compared with control group. Conclusion BiBAP ventilation combined with Coramine is effective in COPD complicated with severe hypereapnia or mild pulmonary encephalopathy, but the efficacy is limited in COPD with moderate pulmonary encephalopathy. Combined with BiBAP ventilation, Coramine will not increase oxygen consumption.