Efficiency observation of non-invasive positive pressure ventilation combined with respiratory stimulants in the treatment of chronic obstructive pulmonary disease patients complicated with pulmonary encephalopathy
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摘要:目的 探讨无创正压通气(BiPAP)联合呼吸兴奋剂治疗慢性阻塞性肺疾病(COPD)合并肺性脑病的效果。方法 选取COPD合并肺性脑病患者84例, 随机分为对照组与研究组各42例。2组均采取常规对症支持治疗，对照组应用BiPAP呼吸机进行辅助通气治疗，研究组在对照组基础上应用呼吸兴奋剂治疗。比较2组治疗前后动脉血气指标与炎症指标的变化，治疗后格拉斯哥昏迷(GCS)评分、通气时间、住院时间，以及气管插管率与病死率。结果 研究组治疗后动脉血二氧化碳分压显著低于对照组(P < 0.05), 动脉血氧分压显著高于对照组(P < 0.05), pH值无显著差异(P>0.05)。研究组治疗后白介素-10(IL-10)、白介素-8(IL-8)与白介素-6(IL-6)显著低于对照组(P < 0.05)。研究组治疗后GCS评分显著高于对照组(P < 0.05), 通气时间、住院时间均显著短于对照组(P < 0.05)。2组气管插管率与病死率差异无统计学意义(P>0.05)。结论 BiPAP联合呼吸兴奋剂治疗COPD合并肺性脑病疗效确切，可以有效纠正患者动脉血气与炎症指标，缩短通气时间，促进患者康复。Abstract:Objective To investigate the effect of bi-level positive airway pressure (BiPAP) combined with respiratory stimulants in treatment of chronic obstructive pulmonary disease (COPD) patients complicated with pulmonary encephalopathy.Methods A total of 84 COPD patients complicated with pulmonary encephalopathy were selected and randomly divided into control group and study group, with 42 cases in each group. Both groups were treated with routine symptomatic support therapy, while the control group was treated with BiPAP ventilator, and the study group was treated with respiratory stimulants on the basis of control group. The changes of arterial blood gas indexes and inflammation indexes before and after treatment, Glasgow Coma Scale (GCS), ventilation time, hospitalization time, tracheal intubation rate and mortality were compared between the two groups.Results After treatment, the arterial partial pressure of carbon dioxide in the study group was significantly lower than that in the control group (P < 0.05), the arterial partial pressure of oxygen was significantly higher than that in the control group (P < 0.05), and the pH value showed no significant difference between two groups (P>0.05). After treatment, the levels of interleukin-10 (IL-10), IL-8 and IL-6 in the study group were significantly lower than those in the control group (P < 0.05). After treatment, the GCS score in the study group was significantly higher than that in the control group (P < 0.05), and ventilation time and hospitalization time were significantly shorter than those in the control group (P < 0.05). There were no significant differences in the rate of tracheal intubation and mortality between the two groups (P>0.05).Conclusion BiPAP combined with respiratory stimulants is effective in the treatment of COPD complicated with pulmonary encephalopathy, which can effectively correct arterial blood gas indexes and inflammation indexes, shorten ventilation time and promote rehabilitation.
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表 1 2组治疗前后动脉血气指标比较(x±s)
组别 n 动脉血二氧化碳分压/mmHg 动脉血氧分压/mmHg pH值 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 研究组 42 86.5±5.2 54.6±4.5* 35.6±5.6 85.6±5.6* 7.2±0.2 7.3±0.1 对照组 42 86.4±4.8 68.6±5.2 35.8±5.5 68.6±5.8 7.2±0.3 7.3±0.2 与对照组比较, *P < 0.05。 
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表 2 2组治疗前后血清炎症指标的变化比较(x±s)
pg/mL 组别 n IL-10 IL-8 IL-6 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 研究组 42 35.6±2.3 21.3±1.5* 50.6±4.5 31.0±2.8* 40.6±3.5 24.3±2.2* 对照组 42 35.8±2.2 29.0±2.3 50.4±3.8 42.6±3.8 40.5±2.8 33.8±3.5 IL-10: 白介素-10; IL-8: 白介素-8; IL-6: 白介素-6。与对照组比较, *P < 0.05。
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表 3 2组治疗后GCS评分、通气时间、住院时间比较(x±s)
组别 n GCS评分/分 通气时间/d 住院时间/d 研究组 42 12.2±0.6* 6.2±2.0* 11.3±4.8* 对照组 42 10.5±0.6 8.3±2.2 15.8±6.5 GCS: 格拉斯哥昏迷量表。与对照组比较, *P < 0.05。
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