重症COPD急性加重期的救治体会

The treatment experience of acute exacerbation of severe COPD

目的本文通过回顾2007年1月～2008年4月笔者所在医院ICU病房的COPD急性加重患者22例的救治经过，总结治疗经验。方法（1）机械通气：采用呼吸机序贯治疗直至撤机。（2）抗炎和解痉：初期采用经验治疗，以后根据痰培养结果针对用药。使用爱喘乐及稀释的碳酸氢钠雾化液雾化吸入，缓解气道阻塞和炎症。（3）多脏器功能不全的治疗。（4）加强营养支持治疗。结果20例成功，2例死亡皆因家属放弃治疗，其中1例出现气压伤。结论（1）重症COPD急性加重时，引起肺通气和换气功能严重障碍，常见Ⅱ型呼衰，为患者死亡的主要原因。机械通气治疗有效引流痰液，协助控制肺部感染，解除呼吸肌疲劳，从而迅速改善呼衰。（2）控制感染采用“重锤猛击”策略，以后根据痰培养药敏结果选择用药。（3）保护脏器功能。（4）加强营养支持治疗成为COPD患者的重要治疗手段。（5）COPD患者早期监测肺功能，及时采取治疗措施，应成为临床研究课题。

Objective This paper reviews from January 2007 to April 2008 ICU patients with acute exacerbation of COPD ward of 22 cases after treatment, summed up the treatment experience. Methods （ 1 ） Mechanical ventilation ： use of sequential treatment until ventilator weaning. （2） Anti - inflammatory and antispasmodic treatment of early use of the experience, after the sputum culture results for the drug under. Use of atrovent and diluted sodium bicarbonate solution inhalation aerosol, airway obstruction and inflammation relief. （3）Multiple organ dys- function treatment. （4）To enhance nutritional support therapy. Results Of 20 cases successfully. 2 cases died because the family gave up the treatment, 1 patient had pneumothorax. Conclusion （ 1 ） Severe acute exacerbations of COPD, causing pulmonary ventilation and gas exchange function was impaired, the common type Ⅱ respiratory failure,leading cause of death for patients. Mechanical ventilation and effective drainage of mucus, to help control lung infections, relieve respiratory muscle fatigue, which rapidly improved respiratory failure. （ 2 ） Control the infection. We use hammer bang strategy, after the sputum culture results of susceptibility under medication. （3）To protect organ function. （4）To enhance nutri- tional support treatment as an important treatment for patients with COPD. （5）COPD lung function in patients with early detection, timely treatment measures, should be the subject of our clinical study.