丙泊酚用于精神病患者人工通气镇静治疗的临床效果评价

目的研究丙泊酚对精神病患者人工通气在治疗慢性阻塞性肺疾病（COPD）伴重度高碳酸性呼吸衰竭的镇静效果。方法将44例COPD伴重度高碳酸性呼吸衰竭的精神病患者按入院顺序完全随机分为2组各22例，对照组：咪唑安定静脉注射10—20mg；丙泊酚组：丙泊酚静脉注射泵持续输注0．5～2．0mg/（kg·h），比较治疗0．5、1h后，2组动脉血气分析中的pH值、氧分压（PaO2）、二氧化碳分压（PaCO2）变化，峰值气道压力（Pmax）、平台压（Ppalt）以及肺功能中第1秒用力呼气量与用力肺活量的比值（FEV1／FVC）和呼气峰流速（PEF）的变化。结果丙泊酚组的镇静效果显著优于对照组；与对照组比较，丙泊酚组在治疗后PaCO2显著降低，pH值在治疗后0．5h回到正常范围内，恢复较迅速（P〈0．05或P〈0．01）；治疗后0．5h的PaO2、PaO2／FiO2也比对照组明显升高。丙泊酚组在治疗后的Pmax、Ppalt较对照组有明显下降，PEF、FEV1／FVC的提高较对照组显著，差异有统计学意义（P〈0．05或P〈0．01）。结论丙泊酚进行镇静在COPD伴重度高碳酸性呼吸衰竭治疗中可降低气道阻力，改善氧合功能，减少精神病患者的人机对抗。

The clinical efficacy of Propofol on severe hypercapnic respiratory failure in psychopathy during mechanical ventilation

Objective To study patients with chronic obstructive pulmonary diseases(COPD) with severe hypercapnic respiratory failure for Sedation in psychopathy during mechanical ventilation. Methods Forty-four cases of COPD with severe hypercapnic respiratory failure were divided into two groups, patients (n = 22) inControl The comparison was made on the changes of pH, PaO2, PaCO2in the arterial blood gas before and after the treatment 0. 5 h, 1 h, between the two groups. And also the changes of Pmax, Ppalt, PEF, FEV1/ FVC in pulmonary function between the two groups. Results Significant differences were found in the Propofol group of the improvement of pH, PaO2, PaO2/FiO2, PEF, FEV1/ FVC in pulmonary function and the decreased value of PaCO2, Pmax, Ppahbefore and after the treatment, compared with the control group (P < 0. 05～0. 01). Conclusion Propofol infusion have an excellent effect for sedation in ventilation patients with COPD with severe hypercapnic respiratory failure, can decrease airway resistance, improve the oxygenation in lung, Also can maintain the coordination between spontaneous breath and mechanic ventilation in psychopathy.