双水平气道正压通气联合雾化吸入治疗AECOPD临床研究

目的探讨双水平气道正压通气(BiPAP)呼吸机加雾化吸入复方异丙托溴铵溶液治疗慢性阻塞性肺疾病急性加重(AECOPD)的临床疗效。方法 96例AECOPD患者随机分为治疗组和对照组。两组患者均根据痰培养及药敏结果选用敏感抗生素,纠正酸碱失衡及水、电解质紊乱,给予解痉平喘、止咳祛痰及营养支持等常规治疗,并使用BiPAP呼吸机治疗。治疗组在此基础上加用复方异丙托溴铵溶液2 ml(含异丙托溴铵4 mg,沙丁胺醇2 mg)加生理盐水3 ml雾化吸入15~20 min,2次/d。结果 1治疗组总有效率为91.7%(44/48),对照组总有效率为81.3%(39/48),两组比较差异有统计学意义(P0.05);2治疗组死亡1例,对照组死亡3例,两组对比差异无统计学意义(P0.05)。3治疗后两组动脉血二氧化碳分压逐渐下降,治疗组下降更明显,两组比较差异均有统计学意义(P0.01)。治疗后两组动脉血氧分压、pH、动脉血氧饱和度逐渐升高,治疗组升高更明显,两组比较差异均有统计学意义(P0.05或P0.01)。4治疗后两组心率、呼吸频率逐渐下降,治疗组下降更明显,两组比较差异均有统计学意义(P0.05或P0.01)。5治疗组与对照组通气时间、住院天数比较差异有统计学意义(P0.01),治疗组通气时间、住院天数均比对照组缩短。结论 BiPAP联合雾化吸入复方异丙托溴铵溶液治疗AECOPD具有疗效显著、操作简单、安全方便等优点,值得在临床推广应用。

Clinical research of bi-level positive airway pressure ventilation combined with atomization inhalation in the ;treatment of AECOPD patients

Objective To study the clinical efficacy of bi-level positive airway pressure ventilation（ BiPAP）ventilator combined with nebulized ipratropium bromide in the treatment of AECOPD. Methods 96 AECOPD patients were randomly divided into the treatment group and the control group. All patients were given related antibiotics based on the results of drug sensitivity test,correction of acid-base imbalance and water,electrolyte disturbance,antispasmodic,cough expectorant and nutritional support,and BiPAP ventilator therapy. The treatment group was additionally treated with compound ipratropium bromide solution（ ipratropium bromide 4 mg,salbutamol 2mg） for 2 ml plus saline aerosol inhalation of 3 ml 15 to 20 min,twice a day. Results ① The total effective rate was 91. 7%（ 44/48） in the treatment group and81.3%（ 39/48） in the control group（ P〈0.05）. ② There was1 case of death reported in the treatment group and 3 cases in the control group（ P〉0. 05）. ③ After the treatment,the decrease of arterial partial pressure of carbon dioxide was more obviously in the treatment than in the control group（ P〈0. 01）.The increase of pH and arterial oxygen partial pressure of arterial oxygen saturation was more pronounced in the treatment group than in the control group.④ The heart rate and respiratory rate decreased gradually after the treatment in the two groups,and the decrease was more pronounced in the treatment group than in the control group（ P〈0. 05 or P〈0. 01）. 5 There were significant differences in ventilation time and duration of hospital stay between the two groups（ P〈0. 01）. Conclusion BiPAP combined with nebulized ipratropium bromide solution has obvious curative effect with the advantages of simple operation and high safety in the treatment of AECOPD.