尼可刹米联合无创正压通气治疗慢性阻塞性肺疾病呼吸衰竭并发肺性脑病40例临床观察

Clinical Observation of Nicothamide Combined with Non-invasive Positive Pressure Ventilation in the Treatment of 40 Cases of COPD Respiratory Failure Complicated with Pulmonary Encephalopathy

目的:探讨尼可刹米联合无创正压通气治疗慢性阻塞性肺疾病(慢阻肺)呼吸衰竭并发肺性脑病的临床疗效。方法:采用随机数字表法,将2017年3月至2020年3月景德镇市第二人民医院收治的80例慢阻肺呼吸衰竭并发肺性脑病患者分为两组,各40例。两组均予以常规抗感染和解痉平喘治疗,对照组在此基础上予以无创正压通气治疗,观察组在对照组基础上同时予以尼可刹米治疗,均治疗3 d。对比两组氧合指数、动脉血气指标及呼吸困难量表(mMRC)评分。结果:治疗后,观察组氧合指数高于对照组,差异有统计学意义(P<0.05);治疗后,观察组动脉二氧化碳分压(PaCO2)水平低于对照组,动脉血氧分压(PaO2)水平高于对照组,差异有统计学意义(P<0.05);治疗后,观察组mMRC评分低于对照组,差异有统计学意义(P<0.05);观察组气管插管率及并发症发生率均显著低于对照组,而人机同步率显著高于对照组,差异有统计学意义(P<0.05)。结论:尼可刹米联合无创正压通气治疗可改善慢阻肺呼吸衰竭并发肺性脑病患者的氧合指数,调节动脉血气指标,改善呼吸困难症状,可降低气管插管率和并发症发生率,具有一定安全性。

Objective:To investigate the clinical efficacy of nikethamide combined with non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease respiratory failur with pulmonary encephalopathy.Methods:According to the random number table method,80 patients with chronic obstructive pulmonary disease respiratory failure and pulmonary encephalopathy treated in Second People's Hospital of Jingdezhen from March 2017 to March 2020 were divided into 2 groups,40 cases in each.Both groups were treated with conventional anti-infection,antispasmodic and antiasthmatic,and the control group was treated with non-invasive positive pressure ventilation on this basis,the observation group was treated with nikethamide on the basis of the control group,and both were treated for 3 days.The oxygenation index,arterial blood gas index and dyspnea scale(mMRC)scores in both groups were compared.Results:After treatment,compared with the control group,the oxygenation index of the observation group was higher,with a statistical significant difference(P<0.05);After treatment,compared with the control group,the arterial carbon dioxide partial pressure(PaCO2)level in the observation group was lower,and the arterial blood oxygen partial pressure(PaO2)level was higher,with statistical significant differences(P<0.05);After treatment,compared with the control group,the mMRC score of the observation group was lower,with a statistical significant difference(P<0.05);the tracheal intubation rate and complication rate of the observation group were significantly lower than those of the control group,while the synchronization rate of man-machine was significantly higher than that of the control group,the difference was statistically significant(P<0.05).Conclusion:The treatment of nikethamide combined with non-invasive positive pressure ventilation can improve the oxygenation index of patients with chronic obstructive pulmonary disease respiratory failure and pulmonary encephalopathy,adjust arterial blood gas indexes,and improve the symptoms of dyspnea,and reduce the tracheal intubation rate and the complication rate,and has a certain degree of safety.