黄怀焕　林俊锋

[摘要] 目的 探讨噻托溴铵加用布地奈德福莫特罗粉吸入剂联合无创通气治疗慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的效果。 方法 分析2011年1月～2014年1月广东省陆丰市人民医院收治的COPD合并Ⅱ型呼吸衰竭患者150例的临床资料，依据治疗措施不同进行分组，常规治疗组50例和联合治疗组100例。常规治疗组采用常规治疗措施，联合治疗组采用噻托溴铵加用布地奈德福莫特罗粉吸入剂联合无创通气治疗，观察两组患者治疗前后呼吸频率、心率、氧分压（PaO2）和二氧化碳分压（PaCO2）情况；观察两组患者治疗前后肺功能、1 s用力呼吸容积（FEV1）、1 s用力呼吸容积/用力肺活量比值（FEV1/FVC）、FEV1占预计值的百分比（FEV1%）；比较两组患者临床治疗效果；观察两组患者气管插管率、病死率情况。 结果 联合治疗组治疗后呼吸频率、心率、PaO2、PaCO2均优于常规治疗组（t=7.01、6.36、6.14、8.46，均P < 0.05），联合治疗组治疗后FEV1、FEV1/FVC、FEV1%均优于常规治疗组（t=11.86、14.59、15.30，均P < 0.05），联合治疗组患者临床治疗总有效率明显优于常规治疗组（χ2=38.10，P < 0.05），联合治疗组气管插管率、病死率均低于常规治疗组（χ2=35.29、10.53，均P < 0.05）。 结论 噻托溴铵加用布地奈德福莫特罗粉吸入剂联合无创通气治疗COPD合并Ⅱ型呼吸衰竭临床症状改善明显，疗效良好，值得临床推广应用。

[关键词] 噻托溴铵；布地奈德福莫特罗粉吸入剂；无创通气；慢性阻塞性肺疾病；Ⅱ型呼吸衰竭

[中图分类号] R563.8 [文献标识码] A [文章编号] 1673-7210（2015）02（b）-0091-04

[Abstract] Objective To approach effect of Tiotropium Bromide and Budesonide and Formoterol Fumarate Powder for Inhalation combined with noninvasive ventilation in the treatment of chronic obstructive pulmonary disease （COPD） and type 2 respiratory failure. Methods The 150 cases clinical data of COPD and type Ⅱrespiratory failure patients from January 2011 to January 2014 in the People's Hospital of Lufeng City were analyzed， and they were divided into two groups， conventional treatment group （50 cases） and combined treatment group （100 cases）. The conventional treatment group was given routine therapy， the combined treatment group was given Tiotropium Bromide and Budesonide and Formoterol Fumarate Powder for Inhalation combined with noninvasive ventilation. The RR， HR， PaO2 and PaCO2 of two groups were observed in pretherapy and post-treatment； the pulmonary function， FEV1， FEV1/FVC， FEV1% of two groups were detected in pretherapy and post-treatment； the clinical curative effect of two groups was compared； the endotracheal intubation rate， death rate of two groups were detected. Results The RR， HR， PaO2 and PaCO2 of the combined treatment post-treatment were better than those of the conventional treatment group （t=7.01， 6.36， 6.14， 8.46； all P < 0.05）， the FEV1， FEV1/FVC， FEV1% of the combined treatment group in post-treatment were better than those of the conventional treatment group （t=11.86， 14.59， 15.30； all P < 0.05）. Total effective rate of the combined treatment group was better than the conventional treatment group （χ2=38.10， P < 0.05）， the endotracheal intubation rate， death rate of the combined treatment group were lower than those of the conventional treatment group （χ2=35.29， 10.53； all P < 0.05）. Conclusion The clinical symptom of COPD and type Ⅱ respiratory failure are improved by Tiotropium Bromide， Budesonide and Formoterol Fumarate Powder for Inhalation and noninvasive ventilation， the curative effect is good， which is worthy of clinical application.

[Key words] Tiotropium Bromide； Budesonide and Formoterol Fumarate Powder for Inhalation；Noninvasive ventilation； COPD；Type Ⅱ respiratory failure

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是呼吸内科常见的疾病，其常合并Ⅱ型呼吸衰竭，严重者危及患者的生命安全，选择有效的治疗措施对于提高临床疗效、挽救患者生命具有重要的意义[1-2]。无创正压通气作为呼吸内科常用的治疗措施，其创伤小、操作简便，可以对肺的氧合和通气进行有效的维持，从而在一定程度上缓解COPD合并Ⅱ型呼吸衰竭的临床症状[3-4]。本研究通过对广东省陆丰市人民医院（以下简称“我院”）COPD合并Ⅱ型呼吸衰竭患者……