纳洛酮治疗肺性脑病的临床分析

目的探讨纳络酮治疗肺性脑病的临床效果。方法 48例临床确诊的肺性脑病患者随机分为对照组24例和治疗组24例,对照组给予持续低流量吸氧、抗炎、解痉、平喘、祛痰、纠正水电解质酸碱平衡等常规治疗,治疗组在对照组的基础上给予纳洛酮,观察2组患者临床疗效。结果治疗组显效率、有效率和无效率分别为54.17%、37.50%和8.33%,总有效率91.67%,显著高于对照组(91.67%vs 62.50%,χ2=5.779,P=0.016)。结论应用纳洛酮治疗肺性脑病疗效显著,值得临床推广。     

早期药物治疗慢性呼吸衰竭并肺性脑病临床观察

目的观察盐酸纳洛酮早期治疗慢性呼吸衰竭并肺性脑病的临床效果,探讨慢性呼吸衰竭并肺性脑病早期治疗药物。方法选择62例早期慢性呼吸衰竭并肺性脑病患者,随机分为观察组和对照组,2组均给予治疗原发病、吸氧、应用抗生素、纠正酸碱平衡及电解质紊乱等常规治疗。观察组在常规治疗的基础上,应用盐酸纳洛酮治疗。结果观察组有效率87.5%,对照组有效率63.3%,观察组有效率明显优于对照组（P〈0.05）。结论纳洛酮早期治疗慢性呼吸衰竭并发肺性脑病临床疗效明显,可列为慢性呼吸衰竭并肺性脑病早期治疗药物之一。     

肺性脑病50例临床分析

肺性脑病是由于慢性阻塞性肺疾病(COPD)、肺源性心脏病急性加重期而导致的气流受限,发生的严重缺氧和CO2潴留,若患者短期缺氧,对身体的损害尚可挽救,若长期缺氧加上细菌等毒素影响以及CO2潴留,患者身体会受到严重甚至不可挽回的损伤[1],引起以中枢神经系统功能障碍为主要表现的一种临床综合征,是呼吸内科最常见的危重症,起病     

纳洛酮联合无创机械通气治疗AECOPD并发轻中度肺性脑病疗效观察

目的观察纳洛酮联合BIPAP无创机械通气治疗慢性阻塞性肺疾病急性加重期（AECOPD）并发轻中度肺性脑病的临床疗效。方法选择AECOPD并发呼吸衰竭轻中度肺性脑病患者43例,均在有效抗感染、解痉平喘等常规治疗的基础上予以纳洛酮及BIPAP无创呼吸机辅助通气。分别在通气前、后3h、24h及72h后评价患者症状、意识状况、动脉血气分析。结果 43例中好转40例,失败3例,有效率93.02%,治疗3h后呼吸困难程度、血气指标有所改善,72h后明显好转,差异有统计学意义（P〈0.05）。结论纳洛酮联合BIPAP无创正压机械通气可迅速缓解患者呼吸困难、改善患者意识状态及呼吸肌疲劳情况,是治疗AECOPD并发轻中度肺性脑病的一种有效治疗措施。     

无创通气序贯治疗AECOPD并肺性脑病拔管患者的疗效分析

慢性阻塞性肺疾病是一种常见的慢性呼吸系统疾病,发病率高,病死率高,特别是急性加重期,易出现呼吸衰竭甚至肺性脑病,严重时需给予机械通气。机械通气是呼吸衰竭患者十分重要的生命支持手段,但因为慢性阻塞性肺疾病患者基础肺功能差,极易出现撤机困难、拔管失败,我们采取有创-无创序贯方法防止拔管失败,取得较好效果,报告如下。     

低分子肝素钠治疗肺性脑病的效果分析

随着大气污染增加,我国慢性阻寒性肺疾病（慢阻肺）发病率明显上升,而慢阻肺随着病情的反复,肺功能也在逐渐下降,易出现严重并发症--肺性脑病。肺性脑病如得不到及时有效的治疗,病情可能呈进一步加重,甚至危及生命。我院在常规治疗肺性脑病基础上,联合低分子肝素钠效果满意,现汇报如下。     

低分子肝素在肺性脑病治疗中的作用

目的 探讨低分子肝素在肺性脑病治疗中的作用.方法 将60例肺性脑病患者随机分为2组,治疗组(低分子肝素组)与对照组(非低分子肝素组)各30例,均给予常规治疗,治疗组除常规治疗外,加用低分子肝素,观察2组治疗前后意识、血气分析、血液流变学变化.结果 治疗组意识恢复快,血气及血流变指标改善更明显,2组间差异有统计学意义.结论 低分子肝素对肺性脑病有较好的辅助治疗价值.     

纳洛酮治疗肺性脑病临床疗效观察

目的 观察纳洛酮对肺性脑病的疗效。方法 70例肺性脑病患者随机被分成两组。在常规治疗基础上，治疗组用纳洛酮0．8mg静脉注射，并将纳洛酮1.6—2.4mg加入5％葡萄糖液500ml中持续静滴，疗程5d。结果 治疗组神志转清时间及血气改善时间均明显短于对照组。结论 纳洛酮可以促进肺性脑病患者神志恢复，改善动脉血气。     

纳洛酮治疗慢性呼吸衰竭并发肺性脑病早期患者的疗效

目的探讨纳洛酮治疗慢性呼吸衰竭并发肺性脑病(PE)早期患者临床疗效。方法选取2013-01—2015-01我院诊治的慢性呼吸衰竭并发肺性脑病早期患者77例,随机分为观察组(n=40例)和对照组(n=37例)。观察组在吸氧、抗感染、维持水电解质和酸碱平衡等常规治疗的基础上加用纳洛酮治疗,对照组仅采用常规治疗,2组疗程均为1周。比较2组临床疗效。结果观察组治疗后通气功能明显改善,PaO2的升高和PaCO2的降低都显著优于对照组(P0.05);观察组精神症状改善时间短于对照组(P0.05);观察组治疗后总有效率(87.5%)显著优于对照组(67.6%),差异有统计学意义(P0.05)。结论纳洛酮治疗慢性呼吸衰竭并发肺性脑病早期,能够显著改善患者的临床症状,疗效较好,无不良反应,值得临床推广应用。     

无创正压通气联合纳洛酮治疗慢性阻塞性肺疾病合并肺性脑病

目的探讨无创正压通气联合纳洛酮治疗慢性阻塞性肺疾病(COPD)的临床治疗效果。方法选取2010-06—2013-01我院收治的60例慢性阻塞性肺疾病合并肺性脑病患者,根据用药的不同随机分成治疗组和对照组进行治疗,每组均30例。治疗组常规用药及BIPAP联合纳洛酮治疗,对照组常规治疗及BIPAP治疗,观察2组患者的意识恢复情况、动脉血气变化、气管插管率、治疗有效率、住院时间等指标。结果 2组治疗后意识恢复情况、动脉血气分析指标、气管插管率以及临床治疗有效率、住院时间等各项情况对比差异有统计学意义(P<0.05)。结论 BIPAP联合纳洛酮治疗COPD合并肺性脑病可较快改善患者的临床症状,提高与患者的人机同步率。     

Discontinuation of continuous positive airway pressure treatment in multiple system atrophy

ObjectiveContinuous positive airway pressure (CPAP) is used for the management of sleep-disordered breathing in patients with multiple system atrophy (MSA). However, the long-term outcome after CPAP treatment is yet to be ascertained.MethodsA retrospective study was performed to investigate the frequency and causes of CPAP treatment discontinuation, and to ascertain the determinations of CPAP treatment duration in Japanese patients diagnosed with probable MSA based upon the consensus diagnostic criteria, who were admitted to our hospital from 2001 to 2012.ResultsTwenty-nine consecutive patients treated with CPAP were analyzed. During the observation period, 19 patients (66%) discontinued CPAP treatment. The median CPAP treatment duration was 13.0 months (range, 1–53 months). The major causes for discontinuation were pulmonary infection, respiratory insufficiency of undetermined origin, and CPAP intolerance. On comparing the clinical characteristics of the groups subjected to short- and long-term CPAP treatment, floppy epiglottis was more frequently observed in the short-term group than in the long-term group (64% vs 15%; P = 0.015).ConclusionThe CPAP treatment duration in MSA patients was not long, and floppy epiglottis may be a determinant of the duration of CPAP treatment.     

Continuous positive airway pressure treatment for sleep apnea in older adults

Daytime sleepiness and sleep disordered breathing are increased in older compared to middle-aged adults. The cognitive and cardiovascular sequelae associated with obstructive sleep apnea (OSA) have significant implications for the older adult who may already be suffering from chronic illness. Most of the evidence supporting the utilization of continuous positive airway pressure (CPAP) for the treatment of OSA has been generated from studies employing samples consisting predominately of middle-aged adults. To examine the efficacy of CPAP for the treatment of obstructive sleep apnea in older adults with an emphasis on adherence and related treatment outcomes, this paper reviews findings from clinical trials including older individuals as well as those specifically targeting this population. These studies have demonstrated that following CPAP therapy, older adults have increased alertness, improved neurobehavioral outcomes in cognitive processing, memory, and executive function, decreased sleep disruption from nocturia and a positive effect on factors affecting cardiac function, including vascular resistance, platelet coagulability and other aspects of cardiovascular health. Physiological differences in respiratory structure and function between younger and older adults of similar disease severity are believed to result in older individuals requiring titration at lower CPAP levels. Once initiated, CPAP treatment is tolerated by older adults, including those with Alzheimer's disease. Patterns of adherence in older individuals are consistent with that of middle-aged adults.     

参麦注射液联合无创正压通气治疗慢性阻塞性肺疾病并发肺性脑病疗效观察

目的观察参麦注射液联合无创正压通气治疗慢性阻塞性肺疾病急性加重期并发肺性脑病的临床疗效。方法将40例慢性阻塞性肺疾病急性加重期合并肺性脑病患者随机分为2组：对照组给予西医常规综合治疗联合无创双水平气道正压通气（BiPAP）治疗;治疗组在常规治疗和无创BiPAP治疗基础上联合参麦注射液,观察2组患者治疗前后的临床疗效、血气分析、平均肺动脉压（mPAP）等的变化。结果治疗组临床疗效明显优于对照组,其PaO2、PaCO2、mPAP的改善亦均优于对照组。结论参麦注射液联合无创正压通气治疗慢性阻塞性肺疾病急性加重期并发肺性脑病有良好的效果。     

Apnea burden: efficacy versus effectiveness in patients using positive airway pressure

BackgroundModern continuous positive airway pressure (PAP) machines track hours of use and residual respiratory events while on treatment. A substantial portion of sleep apnea patients are partially compliant, emphasizing the need to distinguish between PAP efficacy and PAP effectiveness in chronic management of patients with sleep apnea.MethodsWe used a combination of three data sources to estimate the sleep apnea burden in a convenience cohort of PAP users from our clinics that were compliant based on Medicare criteria: self-reported habitual total sleep time, and PAP usage times with residual apnea–hypopnea index (AHI) from compliance downloads.ResultsAssuming that the off-PAP time consists of baseline AHI severity, an estimated apnea burden was calculated to estimate PAP effectiveness. Whereas 70% of patients in our cohort showed machine AHI values <5/h, the apnea burden calculations revealed that only one-third of patients are predicted to have an effective AHI <5.ConclusionEstimating PAP effectiveness through the concept of apnea burden has implications for clinical care as well as research trials.     

Evaluation of the auto continuous positive airway pressure efficacy by upper airway pressure measurement

The efficacy of auto continuous positive airway pressure (CPAP) was prospectively evaluated in 11 obstructive sleep apnea cases by the upper airway pressure measurement. Their apnea plus hypopnea index decreased from 68.3+/-20.2/h to 0.5+/-0.9/h during manually adjusted and 9.6+/-14.5/h during auto CPAP The intraesophageal pressure decreased from -88.0+/-34.0 cm H2O to 11.9+/-7.2 cm H2O during manually adjusted and -26.0+/-13.7 cm H2O during auto CPAP. The manually adjusted CPAP level was 9.1+/-1.7 cm H2O and the maximum pressure of the auto CPAP was 9.4+/-2.0 cm H2O. Auto CPAP could automatically detect the optimal CPAP level. However, the efficacy of the auto CPAP was less than that of the manually adjusted CPAP.     

Pregnancy, sleep disordered breathing and treatment with nasal continuous positive airway pressure

OBJECTIVE: To investigate the tolerance, compliance and problems associated with usage of nasal continuous positive airway pressure (CPAP) by pregnant women with sleep disordered breathing (SDB). PATIENTS AND METHOD: Twelve pregnant women diagnosed with SDB received polysomnography (PSG) at entry, CPAP titration, repeat PSG at 6 months gestation (GA) and home monitoring of cardio-respiratory variables at 8 months GA. Compliance was verified by the pressure at the mask. Results from the Epworth sleepiness scale, fatigue scale and visual analogue scales (VAS) for sleepiness, fatigue, and snoring were compared over time. RESULTS: All of the subjects had full term pregnancies and healthy infants. Nightly compliance was at least 4 h initially and 6.5 h at 6 months GA. Nasal CPAP significantly improved all scales compared to entry. VAS scores remained lower at 6 months GA compared to entry. Re-adjustment of CPAP pressure was needed in six subjects at 6 months GA. CONCLUSION: Nasal CPAP is a safe and effective treatment of SDB during pregnancy.