两种方法治疗慢阻肺高碳酸血症临床观察

Clinical observation of mask(nasal)BIPAP ventilation add lung-brain mixture treat hypercapnia in patients with chronic obstructive pulmonary disease

目的观察面(鼻)罩双水平压力调节(BIPAP)通气联合肺脑合剂治疗慢性阻塞性肺病(COPD)高碳酸血症的疗效。方法将60例COPD合并高碳酸血症患者随机分为联合治疗组、BIPAP组、肺脑合剂组,每组20例。在采用临床常规治疗的基础上,联合治疗组应用BIPAP通气每天6h,加肺脑合剂(由可拉明3.75g,安茶碱0.25g,地塞米松10mg)静脉滴注每天1次;BIPAP组应用BIPAP通气每天6h;肺脑合剂组应用肺脑合剂静脉滴注每天1次;7d为1疗程,疗程结束后进行疗效评价。结果联合治疗组患者治疗后二氧化碳分压(PaCO2)显著降低(P<0.01),BIPAP组CO2潴留状况改善(P<0.05),肺脑合剂组CO2潴留状况改善不明显(P>0.05)。临床疗效评价总有效率联合治疗组85.0%、BIPAP组60.0%、肺脑合剂组35.0%。联合治疗组有效率显著高于BIPAP组(P<0.05)和肺脑合剂组(P<0.01)。结论面(鼻)罩BIPAP通气联合肺脑合剂治疗COPD高碳酸血症疗效明显优于各自单独使用,值得临床推广。

Objective To observe the effect of Mask（Nasal）BIPAP ventilation add Lung-Brain mixture treat hypercapnia patients with chronic obstructive pulmonary disease.Methods 60 cases of hypercapnia in patients with chronic Obstructive pulmonary disease were divided randomly into the combination therapy group（A group）, BIPAP group（B group）, and the Lung-Brain mixture group（C group）.Each group contains 20 cases. On the basis of clinical routine therapy,group A was given BIPAP ventilation 6 h every day, meanwhile using Lung-Brain mixture （Nikethamide 3.75 g, Aminophyline 0.25 g, Dexamethasone 10mg） intravenous drop once a day for 7 days;group B was given BIPAP ventilation 6 h every day for 7days; and group C was given Lung-Brain mixture intravenous drop once a day for 7 days.Results After above treatment, PaCO2 of group A were decreased significantly（P〈0.01）,CO2 Retention of group B were improved significantly（P〉0.05）,CO2 Retention of group C were not improved significantly（P〈0.05）. Total efficient rate is 85.0% for group A, 60.0% for group B and 35.0% for group C.Total efficient rate of group A was higher significantly than that of group B（P〈0.05） and group C（P〈0.01）. Conclusion The effect of Mask（Nasal）BIPAP ventilation add Lung-Brain mixture treat hypercapnia in patients with chronic obstructive pulmonary disease were much better than that by BIPAP ventilation therapy alone or Lung-Brain Mixture therapy.So it is worthy of being widely applicated in clinic.