双水平气道正压通气与呼吸兴奋剂联合双水平气道正压通气治疗老年慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的临床疗效

Clinical effect of respiratory stimulant combined with bi-level positive airway pressure airway on elderly patients with acute exacerbation of chronic obstructive pulmonary disease and type Ⅱ respiratory failure

目的探讨呼吸兴奋剂与双水平气道正压通气(Bi PAP)联合治疗老年慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭的临床效果,为临床治疗提供参考。方法选择2013年3月至2015年4月80例AECOPD合并Ⅱ型呼吸衰竭患者,按照数字表法分为对照组与观察组,每组40例。对照组使用Bi PAP呼吸机治疗,观察组在对照组的基础上联合使用呼吸兴奋剂治疗。对比治疗前后患者血气指标、生理指标、治疗有效率及转归。结果观察组治疗后1、3 d动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、p H值、动脉血氧饱和度(Sa O2)较治疗前均明显改善,差异有统计学意义(P<0.05);治疗后同时间点观察组Pa O2、Pa CO2、p H、Sa O2较对照组改善明显,差异有统计学意义(P<0.05)。观察组治疗后1、3 d心率、呼吸、血压较治疗前均明显改善,差异有统计学意义(P<0.05),治疗后同时间点观察组心率、呼吸、血压较对照组改善明显,差异有统计学意义(P<0.05)。观察组治疗有效率为95.00%,明显高于对照组的75.00%,差异有统计学意义(χ2=6.874,P=0.001);对照组插管机械通气治疗发生率为17.50%,高于观察组的2.50%,两组比较差异有统计学意义(χ2=5.331,P=0.006)。结论呼吸兴奋剂与双水平气道正压通气联合治疗AECOPD合并Ⅱ型呼吸衰竭临床效果佳,显著改善呼吸衰竭,值得临床推广应用。

Objective To investigate the clinical effect of respiratory stimulant combined with bi-level positive airway pressure airway on elderly patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） and type Ⅱrespiratory failure,and to provide reference for clinical treatment. Methods From December 2012 to April 2015,80 AECOPD patients with type Ⅱ respiratory failure were selected,and they were divided into the control group and the observation group with 40 cases in each group. The control group was given Bi PAP respiratory machine treatment,and the observation group was given stimulant combination therapy in addition. Before and after treatment,the levels of blood gas analysis,physiological indicators,treatment efficiency,outcomes were compared. Results After treatment for 1 and 3 d,the levels of Pa O2,Pa CO2,p H,Sa O2 in the observation group were better than those before treatment（ P 0. 05）. After treatment at the same time,the levels of Pa O2,Pa CO2,p H,Sa O2 in the observation group were better than those in the control group（ P 0. 05）. After 1 and 3 d of treatment,the levels of HR,RR,BP in the observation group were better than those before treatment（ P 0. 05）. After treatment,at the same time,the levels of HR,RR,BP in the observation group were better than those in the control group（ P 0. 05）. In observation group,the treatment efficiency was 95. 00%,which was significantly higher than that in the control group（ 75. 00%）,there was significant difference（ χ2= 6. 874,P = 0. 001）. In the control group,the incidence of intubation with mechanical ventilation was 17. 50%,which was higher than that in the observation group（ 2. 50%）,the difference was significant（ χ2= 5. 331,P = 0. 006）. Conclusion Respiratory stimulants and bi-level positive airway pressure combination therapy has good clinical effect on AECOPD patients with type Ⅱ respiratory failure,it can significant improve the respiratory failure,so is worthy of clinical application.