可拉明与面(鼻)罩BiPAP通气在呼吸衰竭时的合理应用

目的　探讨可拉明以及经面 (鼻 )罩BiPAP呼吸机通气在慢性阻塞性肺病 (COPD)合并呼吸衰竭时的合理应用。方法　COPD合并慢性呼吸衰竭急性加重期的病人 ,在使用可拉明或 (和 )经面 (鼻 )罩BiPAP呼吸机通气治疗前后测血气分析。结果　A组 10例呼吸频率较慢 ,经可拉明静滴后血气分析及症状明显好转 (P <0 .0 1) ;B组 17例呼吸频率较快 ,可拉明静滴后血气分析及症状无明显好转甚至加重 (P >0 .0 5 ) ,经面 (鼻 )罩BiPAP呼吸机通气治疗后缓解 (P <0 .0 1) ;C组 6例经面 (鼻 )罩BiPAP呼吸机无创通气治疗后病情稍好转 ,但PaCO2 不稳定或下降至一定水平后无进一步缓解 (P >0 .0 5 ) ,呼吸频率减慢 (P <0 .0 1) ,加用可拉明后血气分析及症状明显好转(P <0 .0 1)。结论　呼吸频率较慢的COPD合并呼吸衰竭病人使用呼吸兴奋剂疗效较好 ,呼吸频率较快的病人使用呼吸兴奋剂效果差 ,使用BiPAP呼吸机通气治疗后症状好转 ,少数病例经BiPAP面罩通气治疗后症状好转不满意 ,若呼吸频率也减慢可适当加用呼吸兴奋剂

The Application by Coramine and Mask-to-Face Ventilation using BiPAP Ventilator in COPD Patients Complicated by Respiratory Failure

Objective To study the effect of a kind of respiratory stimulants (coramine) and the mask-to-face ventilation using BiPAP ventilator in COPD patients complicated by respiratory failure.Methods Thirty three COPD patients complicated by respiratory failure in their acute exacerbation stage were involved in this study.They were divided into three groups (group A,B and C).The clinical manifestation and blood gas analysis were recorded before and after using coramine and mask-to-face ventilation.Result The clinical manifestation and blood gas analysis of ten patients in group A with slow respiratory rate were notably improved ( P <0.01) after using coramine.There were seventeen patients in group B with rapid respiratory rate,no improvements were observed after using coramine( P >0.05),after using mask-to-face ventilation,their clinical manifestation and blood gas analysis were notably improved ( P <0.01).The clinical manifestation of six patients in group C was improved while their PaCO 2 level was not improved ( P >0.05) after using mask-to face ventilation with their respiratory rate reducing.After combined with using coramine,their clinical manifestation and blood gas analysis were notably improved ( P <0.01).Conclusion The application of respiratory stimulants is effective in COPD patients complicated by respiratory failure with slow respiratory rate,while not effective in patients with rapid respiratory rate.Using mask-to-face ventilation by BiPAP ventilator is beneficial to patients with rapid respiratory rate.For several patients there is no improvement after using mask-to-face ventilation.The therapy,combined with uing respiratory stimulants is effective if their respiratory rate is reduced.