CAJ | 학술논문

目的：探讨无创正压通气（NIPPV）联合呼吸兴奋剂治疗 COPD 并发早期肺性脑病患者的治疗效果。方法将入选的48例 COPD 合并呼吸衰竭早期肺性脑病患者，随机分为治疗组和对照组，治疗组除常规治疗和 NIPPV 外，使用呼吸兴奋剂，对照组常规治疗和 NIPPV。观察两组插管率、临床痊愈情况、病死率、格拉斯哥昏迷评分（GCS）及动脉血气分析的变化，观察患者对 NIPPV 的耐受情况及不良反应。结果与对照组相比，治疗组治疗2 h、24 h 和72 h 后，其血气指标与对照组的同期观测值差异有统计学意义（P ＜0．05），而 GCS 评分在治疗24 h 和72h 后也与对照组同期观测值差异有统计学意义[24 h：（13．4±1．6）比（11．8±2.1），P ＜0.05；72 h：（14．6±1．5）比（12．4±2．4），P ＜0．05]。且治疗组的气管插管率低（12．0％比56．5％， P ＝0.001），意识恢复时间快[（3．0±0．5）h 比（5．6±0．7）h，P ＝0．023]、ICU 住院时间短[（12．6±1．5）d 比（19.2±1．8）d，P ＝0.004）]，临床痊愈情况好（22／25比10／23，P ＝0．001），但病死率差异无统计学意义（1／25比4／23，P ＝0.129）。结论NIPPV 联合呼吸兴奋剂是治疗 COPD 合并早期肺性脑病有效、安全、简便的治疗方法，可明显改善患者临床症状，改善血气指标，意识恢复时间快，早期使用可避免气管插管，但应密切观察病情变化，若无改善应及时行有创机械通气治疗。
목적：탐토무창정압통기（NIPPV）연합호흡흥강제치료 COPD 병발조기폐성뇌병환자적치료효과。방법장입선적48례 COPD 합병호흡쇠갈조기폐성뇌병환자，수궤분위치료조화대조조，치료조제상규치료화 NIPPV 외，사용호흡흥강제，대조조상규치료화 NIPPV。관찰량조삽관솔、림상전유정황、병사솔、격랍사가혼미평분（GCS）급동맥혈기분석적변화，관찰환자대 NIPPV 적내수정황급불량반응。결과여대조조상비，치료조치료2 h、24 h 화72 h 후，기혈기지표여대조조적동기관측치차이유통계학의의（P ＜0．05），이 GCS 평분재치료24 h 화72h 후야여대조조동기관측치차이유통계학의의[24 h：（13．4±1．6）비（11．8±2.1），P ＜0.05；72 h：（14．6±1．5）비（12．4±2．4），P ＜0．05]。차치료조적기관삽관솔저（12．0％비56．5％， P ＝0.001），의식회복시간쾌[（3．0±0．5）h 비（5．6±0．7）h，P ＝0．023]、ICU 주원시간단[（12．6±1．5）d 비（19.2±1．8）d，P ＝0.004）]，림상전유정황호（22／25비10／23，P ＝0．001），단병사솔차이무통계학의의（1／25비4／23，P ＝0.129）。결론NIPPV 연합호흡흥강제시치료 COPD 합병조기폐성뇌병유효、안전、간편적치료방법，가명현개선환자림상증상，개선혈기지표，의식회복시간쾌，조기사용가피면기관삽관，단응밀절관찰병정변화，약무개선응급시행유창궤계통기치료。
Objective To explore the efficacy of noninvasive positive pressure ventilation technology com-bined with respiratory stimulant in the treatment of pulmonary encephalopathy in patients with COPD.Methods For-ty -eight COPD patients with early pulmonary encephalopathy were included.They were randomly divided into the treatment group and control group.The treatment group was treated by not only regular treatment and noninvasive posi-tive pressure ventilation technology,but also respiratory stimulant.The control group was only treated by regular treat-ment and noninvasive positive pressure ventilation technology.The indexes were recorded,including tracheal intubation rate,clinical recovery rate,mortality,Glasgow coma score,arterial blood gas analysis and adverse reactions.Results Compared with the control group,the arterial blood gas analysis of treatment group on the 2h,24h and 72h were statis-tically significant different(P <0.05).The GCS score on the 24h and 72h were also statistically significant different [24h,(13.4 ±1.6)vs.(11.8 ±2.1),P <0.05;72h,(14.6 ±1.5)vs.(12.4 ±2.4),P <0.05].The treatment group had lower tracheal intubation rate(12% vs.56.5%,P =0.001),shorter consciousness recovery time[(3.0 ± 0.5)h vs.(5.6 ±0.7)h,P =0.023],shorter hospitalization time in ICU[(12.6 ±1.5)d vs.(19.2 ±1.8)d,P =0.004]and better clinical recovery(22 /25 vs.10 /23,P =0.001)than the control group.But the mortality rate had no significant difference between the two groups(1 /25 vs.4 /23,P =0.129).Conclusion NIPPV combined with respiratory stimulant is an effective,safe and simple method for treatment of COPD complicated with pulmonary encephalopathy.It can significantly improve the clinical symptoms and the index of arterial blood gas analysis,and it can shorten consciousness recovery time and decrease tracheal intubation rate.But close observation must be carried out,and the invasive mechanical ventilation should be promptly executed in case of emergency or exacerbation.