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目的:研究高流量氧气驱动布地奈德混悬液雾化吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)并Ⅱ型呼吸衰竭的安全性。方法:139例AECOPD并Ⅱ型呼吸衰竭住院患者随机分为治疗组(布地奈德混悬液)与对照组(布地奈德混悬液+沙丁胺醇雾化液),2组患者除雾化吸入治疗不同外,其他治疗均相同。观察2组患者第1天雾化吸入治疗前、治疗结束后的即时血气分析及心率变化。结果:治疗组治疗前、后动脉血氧分压(PaO2)分别为(50.8±6.11)、(79.6±7.03)mmHg,t=3.41,P<0.05;动脉血二氧化碳分压(PaCO2)分别为(68.3±5.46)、(71.3±6.56)mmHg,t=1.51,P>0.05;心率分别为(112.6±10.23)、(105.7±9.68)次/min,t=1.01,P>0.05。对照组治疗前、后PaO2分别为(51.6±5.98)、(80.1±6.67)mmHg,t=3.53,P<0.05;PaCO2分别为(67.8±6.71)、(50.1±5.73)mmHg,t=2.98,P<0.05;心率分别为(115.4±9.87)、(126.9±11.48)次/min,t=1.09,P>0.05。2组治疗后心率比较,t=1.97,P<0.05。结论:高流量氧气驱动布地奈德混悬液吸入治疗AECOPD并Ⅱ型呼吸衰竭安全、有效,但单用布地奈德混悬液治疗有增加PaCO2的趋势,而联用布地奈德+沙丁胺醇氧气驱动雾化吸入能显著改善AECOPD并Ⅱ型呼吸衰竭患者的高碳酸血症,但具有一定的增加心率的作用。
OBJECTIVE: To study the safety of inhalation of budesonide suspension driven by high flow oxygen to treat acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and type Ⅱ respiratory failure. Methods: One hundred and ninety-three patients with AECOPD and type Ⅱ respiratory failure were randomly divided into treatment group (budesonide suspension) and control group (budesonide suspension + salbutamol nebulizer solution), and two groups were given anti-nebulization therapy Different, other treatments are the same. Two groups of patients on the first day after inhalation treatment before treatment, real-time blood gas analysis and heart rate changes after treatment. Results: Before and after treatment, PaO2 were (50.8 ± 6.11) and (79.6 ± 7.03) mmHg, respectively, t = 3.41, P <0.05; PaCO2 of the treatment group were 68.3 ± 5.46), (71.3 ± 6.56) mmHg, t = 1.51, P> 0.05; heart rate were (112.6 ± 10.23), (105.7 ± 9.68) times / min, t = 1.01, P> 0.05 respectively. PaO2 were (51.6 ± 5.98), (80.1 ± 6.67) mmHg, t = 3.53, P <0.05 respectively in the control group; PaCO2 was (67.8 ± 6.71), (50.1 ± 5.73) mmHg, P <0.05; heart rate were (115.4 ± 9.87), (126.9 ± 11.48) times / min, t = 1.09, P> 0.052 group after treatment heart rate comparison, t = 1.97, P <0.05. CONCLUSIONS: High-flow oxygen-driven inhalation of budesonide suspension is safe and effective in the treatment of AECOPD and type Ⅱ respiratory failure. However, the treatment with budesonide suspension alone has the tendency of increasing PaCO2, while the combination of budesonide and salbutamol oxygen Atomized inhalation can significantly improve the patients with AECOPD and type Ⅱ respiratory failure of hypercapnia, but with a certain increase in heart rate.