舒利迭联合无创通气抢救老年慢阻肺呼吸衰竭患者临床观察.doc

PAGE PAGE 1舒利迭联合无创通气抢救老年慢阻肺呼吸衰竭患者临床观察 作者：陈振平，刘学芬，黄晓霞，肖　卫　 作者单位：(湖北省荆州市第一人民医院呼吸内科，湖北 荆州　434000) 【摘要】 目的：探讨舒利迭联合无创通气在治疗老年慢性阻塞性肺疾病(COPD)呼吸衰竭的临床疗效。方法：将120例COPD伴有Ⅱ型呼吸衰竭的患者随机分为对照组与观察组，每组60例，两组患者均给予常规治疗。对照组给予双水平气道正压通气(BiPAP)治疗，观察组患者给予舒利迭联合BiPAP治疗，比较两组患者治疗前后血气分析、肺功能变化。结果：治疗后48 h观察组PaO2、PaCO2及PH值显著优于对照组(Plt;0.05);观察组肺功能FEVl、FEV1/ FVC、FEV1占预计值百分比显著高于对照组，差异具有统计学意义(Plt;0.05)。结论：舒利迭联合BiPAP治疗COPD伴有Ⅱ型呼吸衰竭可快速减轻患者临床症状，改善生化指标及肺功能，疗效优于单用BiPAP治疗。 【关键词】 慢性阻塞性肺疾病;无创通气;舒利迭 　　[ABSTRACT] Objective： To explore the clinical effect of Seretide combined with noninvasive positive pressure ventilation in treating patients with type Ⅱ respiratory failure caused by chronic obstructive pulmonary disease (COPD). Methods：A total of 120 cases with COPD were randomly divided into control group and experimental group with 60 patients each group. Patients in both two groups received routine treatment. Patients in control group were given BiPAP treatment， and experimental group received BiPAP combined with Seretide treatment. Blood gas analysis and lung function were compared between two groups. Results：PaO2， PaCO2 and PH 48 hour after treatment in experimental group were superior to control group (Plt;0.05)， and FEVl， FEV1/FVC， FEV1% were significantly higher in experimental group(Plt;0.05). Conclusions：BiPAP combined with Seretide treatment can alleviate clinical symptoms quickly and improve blood gas analysis indexes and lung function. The effect is superior to single BiPAP treatment. 　　[KEY WORDS] Chronic obstructive pulmonary disease; Noninvasive positive pressure ventilation; Seretide 　　慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是常见的一种呼吸系统疾病，以气流受限不完全可逆、呈进行性发展为特点。合并Ⅱ型呼吸衰竭是COPD患者病情加重及死亡的主要原因之一，老年患者心肺贮备功能下降，因此急性加重期时更易出现低氧血症及CO2潴留。无创双水平正压(BiPAP)呼吸机具有双水平无创气道正压通气功能，能迅速有效地纠正缺氧和二氧化碳潴留[1]。而舒利迭是沙美特罗和丙酸氟替卡松的混合剂[2]，为探讨BiPAP联合舒利迭治疗老年COPD合并Ⅱ型呼吸衰竭的临床疗效，本文对120例患者分析如下。 　　1　资料与方法 　　1.1　临床资料 　　选择2009年8月～2011年6月本院住院治疗的120例COPD合并Ⅱ型呼吸衰竭患者，所有患者均符合2002年慢性阻塞性肺疾病诊治指南诊断标准，血气分析结果提示患者合并Ⅱ型呼吸衰竭，PaO2lt;8.0 kPa，PaCO2gt;6.