呼吸兴奋剂在AECOPD并呼吸衰竭患者撤机后的临床应用

Clinical application of respiratory stimulant used in AECOPD and after the respiratory failures off the respirator

目的:观察尼可刹米治疗AECOPD并呼吸衰竭患者撤机后24h内再次出现呼吸衰竭的治疗效果。方法:72例AECOPD并呼吸衰竭撤机后24h内再次出现呼吸衰竭患者,随机分为治疗组39例,对照组33例,两组患者除积极抗感染、解痉、持续低流量吸氧、必要时吸痰等治疗外,治疗组于每天上、下午给予静滴尼可刹米1.125～1.875g,速度约15mg/min,连用3～5d。比较两组的动脉血气分析、总住院时间、治疗成功率、重复插管通气率。结果:治疗组在应用呼吸兴奋剂24h后pH、PaO2、PaCO2均明显改善(P<0.05),对照组仅PaO2有改善(P<0.05),而pH、PaCO2均无改善(P>0.05)。治疗组治疗后动脉血气分析较对照组明显改善,两组治疗24、48、72h的pH、PaO2、PaCO2比较,差异有统计学意义(P<0.05)。治疗组的治疗成功率较对照组高(P<0.05),总住院时间较对照组短(P<0.05),重复气管插管机械通气率较对照组低(P<0.05)。结论:尼可刹米治疗AECOPD并呼吸衰竭患者撤机后再次出现呼吸衰竭,可明显改善患者呼吸衰竭、提高治疗成功率、缩短总住院时间和减少重复气管插管机械通气率。

Objective： To watch over the treatment of nikethamide used in AECOPD and after the recurrence of the respiratory failures off the respirator. Methods： 72 patients in AECOPD with the recurrence of respiratory failures off the respirator were divided into two groups 39 cases for the treatment group and 33 cases for the control group. Both the two groups were given the treatment of resist infection, antispasmodic, continuously low flow inhale oxygen and suctioning necessary. The treatment group were given intravenous drip of nikethamide,1.125-1.875 g,15 mg/min, every morning and afternoon for 3-5 days.Compared the two groups＇ ABG （artery blood gas）, total length of hospital stay, cure rate and ventilation rate of reintubation. Results： pH,PaO2 and PaCO2 of the treatment group improved clearly（P〈0.05） after respiring stimulant for 24 hours. And only PaO2 of the control group improved（P〈0.05）, but pH, PaCO2 didn＇t improve（P〉0.05）. ABG analysis of the treatment group improved more clearly than the control group, pH,PaO2 and PaCO2 of the two groups had a striking difference（P〈0.05） after the treatment for 24, 48 and 72 hours. Compared with the control group, the success rate of the treat- ment group was higher（P〈0.05）, the total hospital stay was shorter（P〈0.05） and the mechanical ventilation rate of re-intubation was lower（P〈0.05）. Conclusion： Nikethamide,used in AECOPD and after the recurrence of respiratory failure off the respirator could clearly improve respiratory failures, increase the success rate of treatment, shorten the total hospital stay and reduce the mechanical ventilation rate of reintubation.