右美托咪定联合无创通气治疗AECOPD并发肺性脑病患者的临床疗效及安全性评价

Clinical effect of dexmedetomidine combined with non-invasive positive pressure ventilation in treatment of patients with AECOPD complicated with pulmonary encephalopathy and evaluation on its safety

目的:观察右美托咪定(Dex)联合无创机械通气在治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发肺性脑病患者中的临床应用,阐明其有效性及安全性。方法:将80例AECOPD并发肺性脑病患者按照随机数字表法分成对照组和Dex组,每组40例,对照组患者给予常规抗炎、化痰、解痉平喘及无创通气等治疗;Dex组患者在上述常规治疗同时联合Dex静脉泵入镇静治疗。分析2组患者治疗前后的心率(HR)、血压、动脉血氧分压(PaO_2)及二氧化碳分压(PaCO_2)、气管插管率、无创通气有效率和无创通气舒适度,同时评估2组患者咳痰能力、谵妄和焦虑情况。结果:经常规抗炎、化痰、解痉平喘和无创通气等综合治疗后,2组患者HR、血压以及动脉血气中PaCO_2水平较治疗前均有所下降,PaO_2较治疗前有所升高,Dex组上述指标改变程度更加明显(P<0.05)。治疗后Dex组患者气管插管率较对照组降低(P<0.05),无创通气有效率较对照组升高(P<0.05),无创通气舒适度较对照组提高(P<0.05);Dex组患者通气功能、咳嗽能力、咳痰次数及咳痰量与对照组比较差异无统计学意义(P>0.05),Dex组患者谵妄发生率和焦虑评分低于对照组(P<0.05)。结论:Dex联合无创通气是治疗AECOPD并发肺性脑病的有效方法,且无明显不良反应发生。

Objective:To observe the clinical application of dexmedetomidine(Dex)combined with non-invasive positive pressure ventilation(NIPPV)in the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pulmonary encephalopathy,and to clarify its effectiveness Methods:A total of 80 patients with AECOPD and pulmonary encephalopathy were collected and divided into control group and Dex group according to the random digit table(n=40).The patients in control group were treated with conventional therapy,including antibiotics,phlegm,spasmolysis and NIPPV and so on.The patients in Dex group were treated with Dex based on conventional therapy.The heart rate(HR),blood pressure,arterial partial pressure of oxygen(PaO 2),arterial partial pressure of carbondioxide,the rate of endotracheal intubation,the effective rate of NIPPV and the compliance of NIPPV of the patients in two groups were analyzed before and after treatment.The expectoration capacity,delirium and anxiety of the patients in two groups were evaluated.Results:After conventional treatment,the HR,blood pressure and PaCO 2 in two groups were lower than before treatment,and the PaO 2 was higher than before treatment;the degrees of changes of the above indicators in Dex group were more obvious,the differences were statistically significant(P<0.05).At the same time,the intubation rate of the patients in Dex group was lower than that in control group(P<0.05),and the effective rate of NIPPV was higher than that in control group(P<0.05),and the compliance was increased(P<0.05).The ventilatory function,cough ability,expectoration frequency and expectoration volume of the patients in Dex group were not significantly different from those in control group(P>0.05).The incidene rate of delirium and anxiety score of the patients in Dex group were lower than those in control group(P<0.05).Conclusion:Dex combined with NIPPV is a safe and effective method in the treatment of the patients with AECOPD and pulmonary encephalopathy without obvious adverse effects.