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

doi:10.13481/j.1671-587x.20180523

吉林大学学报(医学版) ›› 2018, Vol. 44 ›› Issue (05): 1014-1019.doi: 10.13481/j.1671-587x.20180523

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

侯海龙^1,2, 唐颖¹, 曲兴龙¹, 华树成¹

1. 吉林大学第一医院呼吸内科, 吉林长春 130021;
2. 吉林省梅河口市中心医院呼吸内科, 吉林梅河口 135000

收稿日期:2018-03-07 出版日期:2018-09-28 发布日期:2018-11-20
通讯作者: 曲兴龙,主治医师(Tel:0431-88783442,E-mail:1986071869@163.com);华树成,教授,博士研究生导师(Tel:0431-88782305,E-mail:shuchenghua@eyou.com) E-mail:1986071869@163.com;shuchenghua@eyou.com
作者简介:侯海龙(1979-),男,吉林省梅河口市人,主治医师,讲师,医学硕士,主要从事呼吸重症方面的研究。
基金资助:
国家自然科学基金资助课题（81570002）

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

HOU Hailong^1,2, TANG Ying¹, QU Xinglong¹, HUA Shucheng¹

1. Department of Respiratory Medicine, First Hospital, Jilin University, Changchun 130021, China;
2. Department of Respiration Medicine, Meihekou Center Hospital, Jilin Province, Meihekou 135000, China

Received:2018-03-07 Online:2018-09-28 Published:2018-11-20

摘要/Abstract

摘要： 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（PaO₂）及二氧化碳分压（PaCO₂）、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PaCO₂水平较治疗前均有所下降，PaO₂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。

关键词: 慢性阻塞性肺疾病, 肺性脑病, 右美托咪定, 无创通气, 咳嗽能力

Abstract: Objective:To observe the clinical application of dexmedetomidine(Dex) combined with non-invasive positive pressure ventilation(NIPPV) inthe 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(PaO₂), 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 PaCO₂ in two groups were lower than before treatment, and the PaO₂ 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.

Key words: chronic obstructive pulmonary disease, pulmonary encephalopathy, dexmedetomidine, non-invasive positive pressure ventilation, cough capacity

中图分类号:

R563.8

侯海龙, 唐颖, 曲兴龙, 华树成. 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[J]. 吉林大学学报(医学版), 2018, 44(05): 1014-1019.

HOU Hailong, TANG Ying, QU Xinglong, HUA Shucheng. 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[J]. Journal of Jilin University(Medicine Edition), 2018, 44(05): 1014-1019.

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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

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