CAJ | 학술논문

目的研究丙泊酚对精神病患者人工通气在治疗慢性阻塞性肺疾病(COPD)伴重度高碳酸性呼吸衰竭的镇静效果.方法将44例COPD伴重度高碳酸性呼吸衰竭的精神病患者按入院顺序完全随机分为2组各22例,对照组:咪唑安定静脉注射10～20 mg;丙泊酚组:丙泊酚静脉注射泵持续输注0.5～2.0mg/(kg·h),比较治疗0.5、1h后,2组动脉血气分析中的pH值、氧分压(PaO2)、二氧化碳分压(PaCO2)变化,峰值气道压力(Pmax)、平台压(Ppalt)以及肺功能中第1秒用力呼气量与用力肺活量的比值(FEV1/FVC)和呼气峰流速(PEF)的变化.结果丙泊酚组的镇静效果显著优于对照组;与对照组比较,丙泊酚组在治疗后PaCO2显著降低,pH值在治疗后0.5 h回到正常范围内,恢复较迅速(P<0.05或P<0.01);治疗后0.5 h的PaO2、PaO2/FiO2也比对照组明显升高.丙泊酚组在治疗后的Pmax、Ppalt较对照组有明显下降,PEF、FEV1/FVC的提高较对照组显著,差异有统计学意义(P<0.05或P<0.01).结论丙泊酚进行镇静在COPD伴重度高碳酸性呼吸衰竭治疗中可降低气道阻力,改善氧合功能,减少精神病患者的人机对抗.
목적 연구병박분대정신병환자인공통기재치료만성조새성폐질병(COPD)반중도고탄산성호흡쇠갈적진정효과.방법 장44례COPD반중도고탄산성호흡쇠갈적정신병환자안입원순서완전수궤분위2조각22례,대조조:미서안정정맥주사10～20 mg;병박분조:병박분정맥주사빙지속수주0.5～2.0mg/(kg·h),비교치료0.5、1h후,2조동맥혈기분석중적pH치、양분압(PaO2)、이양화탄분압(PaCO2)변화,봉치기도압력(Pmax)、평태압(Ppalt)이급폐공능중제1초용력호기량여용력폐활량적비치(FEV1/FVC)화호기봉류속(PEF)적변화.결과 병박분조적진정효과현저우우대조조;여대조조비교,병박분조재치료후PaCO2현저강저,pH치재치료후0.5 h회도정상범위내,회복교신속(P<0.05혹P<0.01);치료후0.5 h적PaO2、PaO2/FiO2야비대조조명현승고.병박분조재치료후적Pmax、Ppalt교대조조유명현하강,PEF、FEV1/FVC적제고교대조조현저,차이유통계학의의(P<0.05혹P<0.01).결론 병박분진행진정재COPD반중도고탄산성호흡쇠갈치료중가강저기도조력,개선양합공능,감소정신병환자적인궤대항.
Objective To study patients with chronic obstructive pulmonary diseases(COPD) with severe hypercapnic respiratory failure for Sedation in psychopathy during mechanical ventilation. Methods Forty-four cases of COPD with severe hypercapnic respiratory failure were divided into two groups, patients (n = 22) inControl The comparison was made on the changes of pH, PaO2, PaCO2in the arterial blood gas before and after the treatment 0. 5 h, 1 h, between the two groups. And also the changes of Pmax, Ppalt, PEF, FEV1/ FVC in pulmonary function between the two groups. Results Significant differences were found in the Propofol group of the improvement of pH, PaO2, PaO2/FiO2, PEF, FEV1/ FVC in pulmonary function and the decreased value of PaCO2, Pmax, Ppahbefore and after the treatment, compared with the control group (P < 0. 05～0. 01). Conclusion Propofol infusion have an excellent effect for sedation in ventilation patients with COPD with severe hypercapnic respiratory failure, can decrease airway resistance, improve the oxygenation in lung, Also can maintain the coordination between spontaneous breath and mechanic ventilation in psychopathy.