异丙嗪对慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者使用无创正压通气耐受性及安全性的临床观察

目的 评估异丙嗪是否可以提高慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者对无创正压通气（NPPV）的耐受性及其安全性.方法 将41例因AECOPD合并Ⅱ型呼吸衰竭进行NPPV治疗的住院患者随机分为对照组和治疗组,在使用NPPV治疗前半小时,对照组给予生理盐水1 ml,治疗组给予异丙嗪25 mg,分别肌肉注射.观察NPPV治疗过程中患者PaO2、PaCO2、呼吸频率、心率、辅助呼吸肌评分以及NPPV不耐受例数.结果 治疗组患者在NPPV后2小时,PaO2、PaCO2、呼吸频率、心率、辅助呼吸肌评分均明显改善（P＜0.05）,NPPV不耐受例数明显低于对照组.NIPPV后24小时,两组患者PaO2、PaC02、呼吸频率、心率、辅助呼吸肌评分及NPPV不耐受新增例数比较,差异均无统计学意义（P＞0.05）.结论 异丙嗪可以在早期提高AECOPD合并Ⅱ型呼吸衰竭患者对NPPV的耐受性,并且安全性良好.

Clinical analysis about Promethazine used before noninvasive positive pressure ventilation in treating patients with type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease

Objective To analysis the tolerance and salty about Promethazine used before nonin- vasive positive pressure ventilation （NPPV） in treating patients with type II respiratory failure of acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods 41 patients with AECOPD and type II respiratory failure, using NPPV, divided into 2 groups control group and therapy group. Half an hour before NPPV, patients in control group injected with Sodium Chloride while patients in therapy group injected with Promethazine. Analysis arterial partial pressure of oxygen（ PaOz ） ,arterial partial pressure of carbon dioxide（ PaCO2 ） , respiratory rate （RR） , heart rate （HR） , scale for accessory muscle use ,the num- ber of abandoning NPPV. Results At the first 2 hours, patients in therapy group improved rapidly in PaO2, PaCO2, RR, HR, scale for accessory muscle use （ P 〈 0.05 ） and have a lower number of abandoning NPPV. 24 hours later, PaO2, PaCO2, RR, HR, scale for accessory muscle use and the new number of aban- doning NPPV are similar（ P 〉 0.05 ）. Conclusion Promethazine used in patients with type II respiratory failure of AECOPD is helpful to the tolerance of NPPV and the method is safe.