王翔　单洪武++王东波

[摘要] 目的 观察无创正压通气（NIPPV）、参麦注射液联合治疗对慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者的临床疗效。 方法 选取2014年1～12月我院收治的68例COPD合并呼吸衰竭患者，随机分为观察组和对照组，每组各34例，观察组予以NIPPV和参麦注射液治疗，对照组予NIPPV治疗，治疗15 d后观察比较两组治疗前后的血气分析（pH、PaO2、PaO2/FiO2、PaCO2）、纤维蛋白原、D-二聚体及BNP水平变化。 结果 治疗15 d后，两组患者的pH、PaO2、PaO2/FiO2水平均较治疗前明显升高，PaCO2则明显下降，差异均有统计学意义（P<0.05或P<0.01）；观察组PaCO2、PaO2/FiO2与对照组比较，差异有统计学意义（P<0.05或P<0.01）；两组纤维蛋白原、D-二聚体及BNP水平治疗后较治疗前明显降低，且观察组较对照组下降更为显著，差异有高度统计学意义（P<0.01）。 结论 参麦注射液联合无创正压通气治疗COPD合并呼吸衰竭效果显著，还可显著降低患者血浆BNP、纤维蛋白原和D-二聚体水平。

[关键词] 无创正压通气；参麦注射液；慢性阻塞性肺疾病；呼吸衰竭

[中图分类号] R563.9 [文献标识码] B [文章编号] 1673-9701（2016）25-0083-03

Clinical effects of non-invasive positive pressure ventilation combined with shenmai injection in the treatment of COPD complicated with respiratory railure

WANG Xiang SHAN Hongwu WANG Dongbo

Department of Respiratory Medicine， Yizheng Hospital， Drum Tower Hospital Group of Nanjing， Yizheng 211900， China

[Abstract] Objective To observe the clinical curative effects of non-invasive positive pressure ventilation （NIPPV） combined with Shenmai Injection in the treatment of chronic obstructive pulmonary disease （COPD） complicated with respiratory failure. Methods 68 patients with COPD complicated with respiratory failure who were admitted to our hospital from January to December 2014 were selected. They were randomly assigned to the observation group and the control group， with 34 patients in each group. The observation group was given the treatment of NIPPV and Shenmai injection， and the control group was given NIPPV for the treatment. Changes of blood gas analysis（pH， PaO2， PaO2/FiO2， PaCO2）， fibrinogen， D-dimer and BNP levels before the treatment and 15 days after the treatment were observed and compared between the two groups. Results 15 days after the treatment， levels of pH， PaO2， PaO2/FiO2 in both groups were significantly increased compared with those before the treatment， and PaCO2 was significantly reduced. The differences were statistically significant（P<0.05 or P<0.01）； PaO2， PaO2/FiO2 in the observation group were compared with those in the control group， and the differences were statistically significant（P<0.05 or P<0.01）； levels of fibrinogen， D-dimer and BNP levels after the treatment were significantly reduced compared with those before the treatment， but the reduction was more significant in the observation group than that in the control group， and the differences were all statistically significant （P<0.01）. Conclusion Shenmai injection combined with NIPPV in the treatment of COPD complicated with respiratory failure has significant effects， and is also able to significantly reduce patients plasma BNP， fibrinogen and D-dimer levels.

[Key words] Non-invasive positive pressure ventilation（NIPPV）； Shenmai injection； Chronic obstructive pulmonary disease （COPD）； Respiratory failure

呼吸衰竭是慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者最常见的并发症之一，治疗不及时常危及患者生命，导致死亡。无创正压通气（non-invasive positive pressure ventilation，NIPPV）是治疗呼吸衰竭的有效方法，除可以改善呼吸肌疲劳外，还可以增加氧弥散，降低呼吸氧耗[1]。参麦注射液是人参和麦冬组成的方剂，常用于慢性肺心病、休克患者的救治中，可以改善患者的重要脏器功能，提高机体抗应激能力[2]。2014年1～12月，我科近年来采用NIPPV联合参麦注射液治疗COPD合并呼吸衰竭患者，取得了良好的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

2014年1～12月我院呼吸科共收治COPD合并呼吸衰竭患者78例，符合入组条件者68例，年龄49～76岁，平均（61.2±12.5）岁，COPD病史10～41年，平均（20.1±7.2）年。入组标准：（1）肺功能检查证实存在混合型通气功能障碍，符合COPD诊疗指南[3，4]；（2）有咳嗽、咳痰、胸闷、气促等症状，且持续15 d以上；（3）功能性呼吸困难级别2～4级；（4）无NIPPV治疗禁忌证；（5）符合Ⅱ型呼吸衰竭诊断标准[5]。……