无创双水平正压气道通气联合针刺治疗慢性阻塞性肺疾病合并肺性脑病的研究

Research on Combination of Noninvasive Bi-level Positive Pressure Ventilation and Acupuncture Treating in COPD with Pulmonary Encephalopathy

目的:比较无创双水平正压气道通气(BiPAP)联合针刺对慢性阻塞性肺疾病(COPD)合并肺性脑病患者血气分析、人机同步率、气管插管率等指标的影响,评价该疗法的临床疗效。方法:将我院呼吸内科病房住院的COPD合并肺性脑病共60例患者随机分为治疗组和对照组。对照组予常规措施联合BiPAP治疗,治疗组在对照组治疗基础上加用醒脑开窍针刺法,观察两组病例在通气前、通气1 h、4 h、24 h及病情稳定出院时的动脉血气分析结果及治疗过程中人机同步率、气管插管率等指标。结果:纳入统计的治疗组26例患者中,25例治疗成功,1例患者需气管插管机械通气;对照组27例患者中20例治疗成功,7例需气管插管机械通气,治疗组人机同步率明显高于对照组,气管插管率明显低于对照组,差异均具有统计学意义(P<0.05);经治疗成功的治疗组和对照组患者血气分析结果的对比显示在治疗初始的4 h时,治疗组的pH、PaCO2较对照组均有明显的改善(P<0.05),PaO2则无明显差异;在治疗的24 h及治疗结束后治疗组的pH、PaCO2、PaO2均较对照组有明显的改善(P<0.05)。结论:BiPAP联合醒脑开窍针刺法能明显提高COPD合并肺性脑病患者的人机同步率,降低气管插管率,对患者二氧化碳潴留的情况亦有改善,且未观察到明显不良反应。

Objective： To observe the effect on blood gas analysis, synchronization rate and rate of endotracheal intubation in patients with COPD and pulmonary eneephalopathy by combination of noninvasive Bi-level positive pressure ventilation and acupuncture, as well as the clinical effects.Methods： The 60 patients of COPD and pulmonary eneephalopathy in the depart- ment of respiratory medicine were divided into treatment group and control group randomly, those patients in the control group were treated with BiPAP, and that in the treatment group were given BiPAP as well as acupuncture with restoring conscious- ness and resuscitation needling method. The arterial blood gas analysis, synchronization rate and rate of endotracheal intuba- tion in patients were observed before the treatment as well as after the treatment lhours, 4 hours, 24 hours and discharge in stable condition. Results： 25 eases got successful treatment and 1 case needed tracheal cannula in the treatment group（n=26）; there were 20 cases with successful treatment and 7 case with tracheal cannula in the treatment group（n=27）;the synchronization rate in the treatment group was higher than that of the control group and the rate of endotracheal intubation was lower than that of control group, with significant difference（P〈0.05）; in the patients that got successful treatment, the pH and PaCO2 in the treatment group were better than that of the control group（P〈0.05）, after the treatment of 4 hours; the pH, PaCO2 and PaO2 in the treatment group were better than that of the control group（P〈0.05）, after the treatment of 2d hours. Conclusion： The combination of noninvasive Bi-level positive pressure ventilation and acupuncture can improve the synchronization rate, reduce the rate of endotracheal intubation and ameliorate the carbon dioxide retention without no obvious bad effect.