无创正压通气联合呼吸兴奋剂治疗慢性阻塞性肺疾病并发肺性脑病的随机对照研究

Randomized controlled trial of noninvasive positive pressure ventilation technology combined with respiratory stimulant in the treatment of pulmonary encephalopathy in patients with COPD

目的：探讨无创正压通气（NIPPV）联合呼吸兴奋剂治疗 COPD 并发早期肺性脑病患者的治疗效果。方法将入选的48例 COPD 合并呼吸衰竭早期肺性脑病患者，随机分为治疗组和对照组，治疗组除常规治疗和 NIPPV 外，使用呼吸兴奋剂，对照组常规治疗和 NIPPV。观察两组插管率、临床痊愈情况、病死率、格拉斯哥昏迷评分（GCS）及动脉血气分析的变化，观察患者对 NIPPV 的耐受情况及不良反应。结果与对照组相比，治疗组治疗2 h、24 h 和72 h 后，其血气指标与对照组的同期观测值差异有统计学意义（P ＜0．05），而 GCS 评分在治疗24 h 和72h 后也与对照组同期观测值差异有统计学意义[24 h：（13．4±1．6）比（11．8±2.1），P ＜0.05；72 h：（14．6±1．5）比（12．4±2．4），P ＜0．05]。且治疗组的气管插管率低（12．0％比56．5％， P ＝0.001），意识恢复时间快[（3．0±0．5）h 比（5．6±0．7）h，P ＝0．023]、ICU 住院时间短[（12．6±1．5）d 比（19.2±1．8）d，P ＝0.004）]，临床痊愈情况好（22／25比10／23，P ＝0．001），但病死率差异无统计学意义（1／25比4／23，P ＝0.129）。结论NIPPV 联合呼吸兴奋剂是治疗 COPD 合并早期肺性脑病有效、安全、简便的治疗方法，可明显改善患者临床症状，改善血气指标，意识恢复时间快，早期使用可避免气管插管，但应密切观察病情变化，若无改善应及时行有创机械通气治疗。

Objective To explore the efficacy of noninvasive positive pressure ventilation technology com-bined with respiratory stimulant in the treatment of pulmonary encephalopathy in patients with COPD.Methods For-ty -eight COPD patients with early pulmonary encephalopathy were included.They were randomly divided into the treatment group and control group.The treatment group was treated by not only regular treatment and noninvasive posi-tive pressure ventilation technology,but also respiratory stimulant.The control group was only treated by regular treat-ment and noninvasive positive pressure ventilation technology.The indexes were recorded,including tracheal intubation rate,clinical recovery rate,mortality,Glasgow coma score,arterial blood gas analysis and adverse reactions.Results Compared with the control group,the arterial blood gas analysis of treatment group on the 2h,24h and 72h were statis-tically significant different（P 〈0.05）.The GCS score on the 24h and 72h were also statistically significant different [24h,（13.4 ±1.6）vs.（11.8 ±2.1）,P 〈0.05;72h,（14.6 ±1.5）vs.（12.4 ±2.4）,P 〈0.05].The treatment group had lower tracheal intubation rate（12% vs.56.5%,P =0.001）,shorter consciousness recovery time[（3.0 ± 0.5）h vs.（5.6 ±0.7）h,P =0.023],shorter hospitalization time in ICU[（12.6 ±1.5）d vs.（19.2 ±1.8）d,P =0.004]and better clinical recovery（22 /25 vs.10 /23,P =0.001）than the control group.But the mortality rate had no significant difference between the two groups（1 /25 vs.4 /23,P =0.129）.Conclusion NIPPV combined with respiratory stimulant is an effective,safe and simple method for treatment of COPD complicated with pulmonary encephalopathy.It can significantly improve the clinical symptoms and the index of arterial blood gas analysis,and it can shorten consciousness recovery time and decrease tracheal intubation rate.But close observation must be carried out,and the invasive mechanical ventilation should be promptly executed in case of emergency or exacerbation.