无创通气联合纳洛酮治疗慢性呼吸衰竭并肺性脑病的疗效

目的探讨无创通气联合纳洛酮治疗慢性呼吸衰竭并肺性脑病的临床疗效。方法 180例慢性呼吸衰竭并肺性脑病患者随机分为2组,其中对照组单纯应用无创通气,观察组在对照组的基础上使用纳洛酮注射剂,比较2组临床疗效。结果观察组显效率67.78%,对照组为18.89,差异有统计学意义(Z=3.445,P0.05);2组治疗前后pH值、PaCO2、PaO2均明显改善,差异均有统计学意义(P0.05)。结论无创通气联合纳洛酮治疗慢性呼吸衰竭并肺性脑病具有显著疗效。     

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。     

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。     

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。     

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。     

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。     

BiPAP无创机械通气联合纳洛酮醒脑静治疗肺性脑病32例

肺性脑病是AECOPD合并呼吸衰竭的危重表现,也是肺病患者死亡的重要原因,病死率高达50%以上[1]。近年来,BiPAP无创机械通气在AECOPD清醒患者的治疗中得到了广泛的应用,但对于肺性脑病多采取有创呼吸机。本人自2006-11—2012-12采用BiPAP无创机械通气联合纳洛酮醒脑静治疗肺性脑病32例,疗效显著,现报告如下。     

无创正压通气对COPD合并肺性脑病的疗效

目的研究无创正压通气(NPPV)在合并肺性脑病的慢性阻塞性肺疾病(COPD)患者中的疗效。方法选取2014-04—2016-03住院治疗的COPD并肺性脑病患者42例,随机分为NPPV组和对照组,2组均根据病情需要给予常规治疗,NPPV组加用无创呼吸机辅助通气,比较2组治疗前、治疗2h、8h、24h后心率、呼吸频率、动脉血气分析结果、格拉斯哥昏迷评分(GCS)、气管插管情况、住院时间。结果 NPPV组治疗2h、8h、24h后pH值、PaCO2、GCS均优于对照组,NPPV组气管插管率、住院时间均低于对照组。结论 NPPV有利于COPD患者肺性脑病的恢复,降低气管插管率和减少住院时间。     

纳洛酮治疗肺性脑病疗效分析

肺性脑病为慢性胸肺疾病常见的并发症之一,主要是由于呼吸功能衰竭造成大脑严重缺氧及高碳酸血症,导致神经精神障碍的一种综合征,病死率可达30％～45％［1-2］。我院2009-10-2013-10应用纳洛酮治疗肺性脑病取得明显疗效,现报告如下。     

Polyneuropathy associated with chronic hypoxaemia: prevalence in patients with chronic obstructive pulmonary disease

Summary The prevalence of clinical and electrophysiological signs of peripheral nerve disease was evaluated in 151 patients with chronic obstructive pulmonary disease. Patients with concomitant disorders affecting the peripheral nervous system were excluded. Thirty patients had clinical signs of a mild sensorimotor and distal neuropathy and 13 additional patients had only electrophysiological abnormalities. The rate and the severity of the neuropathy correlated with the severity of chronic hypoxaemia. Three out of 20 patients with mild hypoxaemia (PaO₂ less than 15 mm Hg below normal) had polyneuropathy as compared with 15 out of 36 with severe hypoxaemia (PaO₂ more than 30 mm Hg below normal (rates different at the 10% level)). PaO₂ and age were the only variables discriminating between patients with and without peripheral neuropathy.Supported by the Insitut de Recherches Internationales Servier 92202 Neuilly, France. Presented in part at the inaugural meeting of the European Neurological Society, Nice, France, June 1988     

Acute effects of noninvasive ventilation on sleep physiology in patients with moderate to severe stable chronic obstructive pulmonary disease: a pilot study

Objective/backgroundChanges in sleep architecture in patients with Chronic Obstructive Pulmonary Disease (COPD) can be explained by a combination of physiological changes in breathing during sleep, with impairment of respiratory mechanics and reduction of arterial oxygenation. This study aimed to evaluate the acute effects of noninvasive ventilation (NIV) – compared to spontaneous breathing – on sleep latency and stages, and on the occurrence of sleep-related respiratory events, nocturnal hypoxemia, and changes in heart rate (HR) in patients with moderate to severe stable COPD.Patients/methodsPatients completed two polysomnography (PSG) studies: one during spontaneous breathing and one while receiving NIV in bilevel mode and with backup respiratory rate (RR.) setting. Sleepware G3 software was used for the analysis of PSG and pressure, volume, and ventilator flow curves × time.ResultsParticipants were 10 female patients with a mean age of 68.1 ± 10.2 years. NIV during sleep decreased sleep onset latency (17 ± 18.8 min vs 46.8 ± 39.5 min; p = 0.02), increased REM sleep time (41.2 ± 24.7 min vs 19.7 ± 21.7 min; p = 0.03), and decreased the obstructive apnea index (OAI) (0 vs 8.7 ± 18.8; p = 0.01). Lower mean HR (66.6 ± 4.1 bpm vs 70.6 ± 5.9 bpm; p = 0.03) and lower maximum HR (84.1 ± 7.3 bpm vs 91.6 ± 7.8 bpm; p = 0.03) were observed in PSG with NIV.ConclusionsThe use of NIV in patients with moderate to severe stable COPD while they were sleeping increased REM sleep time and decreased sleep onset latency, the number of obstructive respiratory events, and the mean and maximum HR.     

纳洛酮联合BiPAP治疗慢性阻塞性肺疾病合并早期肺性脑病的临床价值

目的研究双水平无创正压通气(BiPAP)联合纳洛酮在慢性阻塞性肺疾病合并早期肺性脑病的临床价值。方法将我院近年来呼吸重症监护室收治的48例慢阻肺呼吸衰竭合并早期肺性脑病患者随机分为2组,对照组采用双水平无创正压通气及常规治疗,治疗组采用双水平无创正压通气联合纳洛酮及常规治疗。结果治疗组神志恢复时间及血气改善时间、有创呼吸机使用率明显低于对照组。结论双水平无创气道正压通气联合纳洛酮治疗慢性阻塞性肺疾病合并早期肺性脑病可以缩短血气改善时间,促进肺性脑病患者神志恢复,降低患者的有创呼吸机使用率,扩展无创正压通气的应用范围。     

Psychological characteristics of patients with chronic obstructive pulmonary disease: a review

OBJECTIVE: The aim of this study was to review research on psychological characteristics in chronic obstructive pulmonary disease (COPD) patients and to summarize the findings of associations between psychological variables and various aspects of life, illness, and health in COPD patients. METHODS: The following databases were searched: Medline, PsycINFO, and the Cochrane Library. RESULTS: A total of 81 studies, published between 1968 and 2004, was identified. The reviewed studies indicated that patients suffering from COPD have a high prevalence of psychological disorders and may function at a reduced level of efficiency due to neuropsychological impairments. Psychological characteristics also seemed to be associated with functional disability and reduced quality of life. CONCLUSION: Psychological characteristics are important variables that interact with physical symptoms, and they should be taken into account when treating COPD patients. More studies with rigorous methodological designs are needed to describe the role of psychological variables in COPD accurately and reliably.     

团体正念减压疗法对慢性阻塞性肺疾病稳定期合并抑郁状态患者的影响

背景 慢性阻塞性肺疾病（COPD）是常见的慢性呼吸系统疾病,COPD患者多伴有焦虑抑郁等负性情绪,对预后存在不良影响。团体正念减压疗法（MBSR）是一种逐渐受到关注的非药物治疗方法,该方法在COPD合并情绪问题中的研究较少。目的 探讨团体MBSR对COPD稳定期患者抑郁状况、正念水平及肺功能等的影响,为团体MBSR在COPD患者中的应用提供参考。方法 连续选取2019年1月-10月在绵阳市第三人民医院呼吸与危重症医学科门诊随访的97例COPD稳定期患者为研究对象,采用随机数字表法分为研究组（n=50）和对照组（n=47）。两组均接受药物治疗和为期8周的常规健康教育,研究组在此基础上接受8周团体MBSR干预。于干预前、干预4周和8周后进行抑郁自评量表（SDS）、五因素正念量表（FFMQ）以及慢性阻塞性肺疾病评估测试表（CAT）评定,并测定肺功能情况。结果 研究组共41例完成研究,对照组为42例。两组SDS、FFMQ以及CAT评分组别×时间的交互作用均有统计学意义（F=54.858、86.161、69.862,P均<0.01）。干预前,两组SDS、FFMQ和CAT评分均无统计学意义（...     

米氮平辅助治疗对慢性阻塞性肺疾病患者负性情绪及肺功能的影响

目的 探讨米氮平辅助治疗对慢性阻塞性肺疾病(COPD)患者的焦虑抑郁情绪及肺功能的影响.方法 选取我院2017年6月～2019年10月期间收治的129例COPD患者作为研究对象,按随机数字表法将研究对象随机分为观察组和对照组.对照组64例患者给予常规对症支持治疗,观察组65例患者在对照组基础上增加米氮平治疗.观察比较两...     

Effect of desipramine on control of ventilation and depression scores in patients with severe chronic obstructive pulmonary disease

Decreased ventilatory responses to carbon dioxide (CO2) correlate with elevated scores on tests for depression in normal subjects and with episodes of endogenous depression in psychiatric patients. Patients with severe chronic obstructive pulmonary disease (COPD) frequently develop resting hypercapnia due to impaired ventilatory mechanics or drive, and may also have elevated scores on tests for depression. Tricyclic antidepressant drugs can improve ventilatory mechanics and possibly drive. We hypothesized that antidepressant drugs might enhance ventilatory drive and improve arterial blood gases in patients with severe COPD and that these improvements might correlate with improvement in depression scores. Therefore, we studied the effects of desipramine versus placebo on spirometry, resting arterial blood gases, hypercapnic ventilatory and mouth occlusion pressure responses, and scores on the Beck and Zung self-rated depression scales. In our patients the resting arterial CO2 (PaCO2) was found to depend almost equally on ventilatory mechanics and drive. In addition, patients with higher depression scores tended to have a lower PaCO2 when the severity of airways obstruction was taken into consideration. In a 16-week, double-blind, crossover comparison of desipramine with placebo, both treatments led to significant improvement in depression scores. Desipramine had no effects on resting PaCO2, spirometry, or ventilatory control.