慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭应用呼吸兴奋剂和双水平气道正压通气治疗比较

Comparison of treatment effects of respiratory stimulant and bilevel positive airway pressure breathing machine in chronic obstructive pulmonary disease with respiratory failure type Ⅱ

目的探讨呼吸兴奋剂、双水平气道正压通气(BiPAP)呼吸机及二者联合使用在治疗AECOPD合并Ⅱ型呼吸衰竭患者的临床疗效。方法 54例AECOPD合并Ⅱ型呼吸衰竭患者分为3组:静滴呼吸兴奋剂治疗组17例,为Ⅰ组;使用BiPAP呼吸机辅助通气者20例,为Ⅱ组;呼吸兴奋剂联合BiPAP呼吸机辅助通气治疗者17例,为Ⅲ组。比较三组患者治疗后1 d、3 d、5 d的血气改善情况、总住院天数及转归。结果Ⅲ组治疗后各时间段血气改善情况均明显优于Ⅰ组(P<0.05),特别是治疗第5天后Ⅲ组PaO2改善值达47.86±12.29 mmHg,明显优于Ⅰ组改善值30.44±14.12 mmHg,PaCO2改善值达21.24±10.04 mmHg,Ⅰ组改善值仅(4.75±7.05)mmHg;Ⅱ组治疗1 d、3 d后的血气改善也优于Ⅰ组(P<0.05),其中治疗3 d后Ⅱ组PaCO2改善值达(8.57±9.00)mmHg,明显优于Ⅰ组改善值(1.55±3.91)mmHg;Ⅲ组治疗3 d、5 d后的血气改善优于Ⅱ组(P<0.05),其中治疗5 d后Ⅲ组PaO2改善值(47.86±12.29)mmHg,Ⅱ组为(39.55±12.22)mmHg;PaCO2改善值达(21.24±10.04)mmHg,优于Ⅱ组改善值(15.18±8.40)mmHg。结论使用BiPAP呼吸机联合呼吸兴奋剂治疗AECOPD合并Ⅱ型呼吸衰竭能使二者的效能发挥最佳,疗效显著。

Objective To discuss the therapeutic effect of respiratory stimulant,bilevel positive airway pressure（BiPAP） breathing machine and the unity use of the respiratory stimulant and BiPAP breathing machine in acute exacerbation of chronic obstructive pulmonary disease with respiratory failure type Ⅱ.Methods A total of 54 cases were divided into three groups：the group Ⅰ include 17 cases was to be dripped infusion of respiratory stimulant.the group Ⅱ include 20 cases was to be treated through BiPAP breathing machine,the group Ⅲ include 17 cases was to be treated through the unity use of the respiratory stimulant and BiPAP breathing machine.The improvement situation of the blood-gases,the total hospital day and the therapeutic result were compared among three groups of patients treated in one day,three days and five days.Results The improvement situation of the blood-gases of the patients of group Ⅲ was more than the patients of group Ⅰ in every phase after treating （P ＜ 0.05）.Especially after 5 days of therapy group Ⅲ PaO2 improvement value reached 47.86 ± 12.29 mmHg,significantly better than that of group Ⅰ that was 30.44 ± 14.12 mmHg,and group Ⅲ PaCO2 improvement value reached 21.24 ± 10.04mmHg,but that of group Ⅰ was 4.75 ± 7.05 mmHg.The improvement situation of the blood-gases of the patients of group Ⅱ was more than the patients of group Ⅰ in one day and three days after treating（P ＜ 0.05）.Especially after 3 days treatment group Ⅱ PaCO2 improvement value reached（8.57 ± 9.00）mmHg,better than that of group Ⅰ that was（1.55 ± 3.91）mmHg.The improvement situation of the blood-gases of the patients of group Ⅲ was more than the patients of group Ⅱ in three days and five days after treating（P ＜ 0.05）.Especially after 5 days of therapy group Ⅲ PaO2 improved value was （47.86 ± 12.29） mmHg,that of group Ⅱ was （39.55 ± 12.22） mmHg,group Ⅲ PaCO2 improved value was （21.24 ± 10.04）mmHg,and better than that of group Ⅱ that was（15.18 ± 8.40） mmHg.Conclusions The unity use of the respiratory stimulant and BiPAP breathing machine could bring into play the most effect of the both in AECOPD with respiratory failure type Ⅱ.