机械通气联合多索茶碱治疗慢性阻塞性肺病急性加重合并肺性脑病患者的临床效果

Clinical effect of mechanical ventilation combined with doxofylline in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary encephalopathy

目的探讨机械通气联合多索茶碱治疗慢性阻塞性肺病急性加重合并肺性脑病患者的临床疗效。方法选取2013年5月至2019年8月本院重症医学科收治的慢性阻塞性肺病急性加重合并肺性脑病患者156例,按照随机对照原则分为治疗组(n=91)和对照组(n=65)。两组患者均行机械通气、抗感染等常规治疗,治疗组在常规治疗基础上应用多索茶碱平喘治疗,对照组在常规治疗基础上应用硫酸特布他林平喘治疗。比较两组治疗前后动脉血pH、氧分压、二氧化碳分压、血氧饱和度指标变化情况。结果治疗后1、2、3、4、7 d,两组PaCO_(2)明显低于治疗前,且PaO_(2)明显高于治疗前,差异有统计学意义(P<0.05);治疗后2 d,治疗组PaCO_(2)明显低于对照组,PaO_(2)明显高于对照组,差异有统计学意义(P<0.05)。治疗后2、3、4、7 d,两组pH值明显高于治疗前,差异有统计学意义(P<0.05)。治疗后8 h、1、2、3、4、7 d,两组SaO_(2)均高于治疗前,差异有统计学意义(P<0.05)。结论紧急气管插管、机械通气联合静脉应用多索茶碱、硫酸特布他林等平喘治疗,可改善慢性阻塞性肺病急性加重合并肺性脑病患者血气指标,且多索茶碱治疗效果优于硫酸特布他林,可明显缩短呼吸衰竭指标好转时间,值得临床推广运用。

Objective To investigate the clinical effect of mechanical ventilation combined with doxofylline in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)with pulmonary encephalopathy.Methods 156 patients with acute exacerbation of COPD and pulmonary encephalopathy were selected from May 2013 to August 2019.According to the principle of randomized control,they were divided into treatment group(n=91)and control group(n=65).Both groups were treated with mechanical ventilation and anti infection.The treatment group was treated with doxofylline on the basis of routine treatment,and the control group was treated with terbutaline sulfate on the basis of routine treatment.The changes of arterial blood pH,oxygen partial pressure,carbon dioxide partial pressure and blood oxygen saturation were compared between two groups before and after treatment.Results The PaCO_(2) of the two groups was significantly lower than that before treatment at the 1,2,3,4,7 d after treatment,and the difference was statistically significant(P<0.05);the PaCO_(2) in the treatment group was significantly lower than that of the control group 2 d after treatment,and the PaO_(2) was significantly higher than that of the control group(P<0.05).The pH value of the two groups was significantly higher than that before treatment on the 2,3,4,7 d after treatment(P<0.05).SaO_(2) in the two groups was higher than before treatment 8 h,1,2,3,4,7 d after treatment,the difference was statistically significant(P<0.05).Conclusion The treatment of asthma such as emergency tracheal intubation,mechanical ventilation and intravenous therapy such as doxofylline and terbutaline sulfate can improve the blood gas index of patients with acute exacerbation of chronic obstructive pulmonary disease and pulmonary encephalopathy.The therapeutic effect of doxocaterine is better than that of terbutaline sulfate,which can shorten the improvement time of respiratory failure index obviously,and it is worth popularizing and applying in clinic.