刘勇进++夏仁瑞++张意仲

[摘要] 目的 探讨无创机械通气联合盐酸氨溴索雾化治疗慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭的效果。 方法 分析我院内一科2014年3月～2015年10月收治的慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者98例临床资料，依据患者治疗方式不同进行分组，常规治疗组48例和联合治疗组50例。观察两组慢阻肺合并Ⅱ型呼吸衰竭患者治疗前后临床症状、血气分析结果和肺功能情况，并比较两组治疗后的临床疗效。 结果 两组患者治疗前呼吸频率、心率、pH值、PaCO2、PaO2、FEV1、FEV1/FVC、FEV1%均无明显差异，治疗后常规治疗组和联合治疗组呼吸频率、心率均低于治疗前， FEV1、FEV1/FVC、FEV1%均高于治疗前，联合治疗组患者治疗后呼吸频率、心率均低于常规治疗组， FEV1、FEV1/FVC、FEV1%高于常规治疗组，治疗后3 h、12 h、72 h常规治疗组和联合治疗组PaCO2均低于治疗前，PaO2均高于治疗前，联合治疗组患者治疗后3 h、12 h、72 h PaCO2均低于常规治疗组，PaO2高于常规治疗组，联合治疗组患者临床治疗总有效率显著高于常规治疗组，差异有统计学意义（P<0.05）。两组患者治疗后均无不良反应发生。 结论 无创机械通气联合盐酸氨溴索雾化治疗慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者临床症状改善明显，血气分析和肺功能得到恢复，疗效良好，值得临床推广。

[关键词] 无创机械通气；盐酸氨溴索；雾化治疗；慢性阻塞性肺疾病；Ⅱ型呼吸衰竭

[中图分类号] R563 [文献标识码] B [文章编号] 1673-9701（2016）23-0029-04

[Abstract] Objective To discuss the effect of noninvasive mechanical ventilation（NIV） combined with ambroxol hydrochloride nebulizer therapy in treatment of chronic obstructive pulmonary disease（COPD） with type Ⅱ respiratory failure （RF）. Methods Clinical materials of 98 patients with COPD+type Ⅱ RF treated in our department from March 2014 to October 2015 were analyzed， and divided based on different therapies into routine therapy group （48 cases） and combined therapy group（50 cases）. The clinical symptoms， results of blood gas analysis and pulmonary function were observed before and after treatment， as well as the clinical efficacy in both groups. Results There were no significant differences in respiratory rate（RR）， heart rate（HR）， pH value， PaCO2， PaO2， FEV1， FEV1/FVC， and FEV1% between two groups before treatment （P>0.05）. After treatment， the RR and HR were lower than before treatment in both groups， and FEV1， FEV1/FVC， and FEV1% were higher than before treatment in both groups. After treatment， the RR and HR were lower in the combined therapy group than in the routine therapy group， and FEV1， FEV1/FVC， and FEV1% were higher in the combined therapy group than in the routine therapy group. At 3 h， 12 h， and 72 h after treatment， values of PaCO2 in both groups were lower than those before treatment， while values of PaO2 were higher than those before treatment. At 3 h， 12 h， and 72 h after treatment， values of PaCO2 were lower in the combined therapy group than in the routine therapy group， while values of PaO2 were higher in the combined therapy group than in the routine therapy group. The overall response rate was significantly higher in the combined therapy group than in the routine therapy group（P<0.05）. There was no adverse reaction in both groups. Conclusion Noninvasive mechanical ventilation combined with ambroxol hydrochloride nebulizer therapy in treatment of chronic obstructive pulmonary disease with type Ⅱ respiratory failure can effectively improve clinical symptoms of patients and restore blood gas analysis and pulmonary function， which is worthy to be promoted.

[Key words] Noninvasive mechanical ventilation； Ambroxol hydrochloride； Nebulizer therapy； Chronic obstructive pulmonary disease； Type Ⅱ respiratory failure

慢性阻塞性肺疾病合并呼吸衰竭是临床常见危重症之一，其主要的临床特征是出现进行性慢性气流阻塞，如慢性阻塞性肺气肿和慢支，若患者病情加重，氧分压<60 mmHg或者二氧化碳分压>50 mmHg，提示患者可能出现Ⅱ型呼吸衰竭[1，2]。盐酸氨溴索是临床上常用的祛痰剂，同时也是一种黏液溶解剂。无创机械通气可以有效地改善患者缺氧状态，提高血氧浓度。……