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Objective To investigate the clinical efficacy of noninvasive positive pressure ventilation for eld-erly patients with chronic obstructive pulmonary disease and respiratory failure.Methods A total of 64 elderly patients with chronic obstructive pulmonary disease and respiratory failure were collected.The patients were treated with conventional therapy,while using BiPAP ventilator line through the nose and mouth mask bilevel noninvasive pos-itive pressure ventilation therapy,and to give effective care.After treatment for 3d,the pH,PaO2 ,PaCO2 ,SaO2 index changes,respiration,heart rate changes and APACHE Ⅱ,GCS and accessory muscle score were observed.Adverse reactions were recorded.Results Before treatment the PH value of patient was (7.30 ±0.06),which significantly increased to (7.36 ±0.03 )after treatment,PaO2 values was significantly increased to (43.58 ±5.54)from (84.52 ±8.27),SaO2 value was significantly increased to (94.93 ±5.61)from (74.86 ±7.25),PaCO2 value from (71.69 ±8.48)decreased to (42.55 ±6.23).There was statistically significant before and after treatment (t =5.98,6.35,4.86,7.23,all P <0.05),respiratory rate,heart rate were significantly improved,showing a significant difference (t =4.87,5.32,all P <0.05 ),APACHE Ⅱ,GCS and accessory muscle scores were significantly improved,which APACHEⅡ,accessory muscle score was significantly lower,GCS score was significantly increased, were statistically significant (t =4.09,4.01,4.33,all P <0.05).Conclusion It shows that noninvasive positive pressure ventilation combined with conventional drug therapy can improve elderly patients with chronic obstructive pulmonary disease and respiratory failure in patients with clinical symptoms,increase ventilation and improve hyper-capnia,clinical efficacy is better,with no serious adverse reactions.
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Objective To investigate the mechanism of Glutathione in the prevention of ventilator-associated lung injury.Methods 30 mechanical ventilation patients who were healthy before were selected and randomly divided into the two groups.Group A was the high tidal volume group:10mL/kg;group B was used the tidal volume plus the injection of Glutathione(2.4g/d).After 48 hours,we collected lavage fluid and use Coomassie brilliant blue to detect the protein content of alveolar lavage fluid of the two groups.Results There was a significant difference (P<0.01)between the two groups.The protein content in group A[(9.90 ±2.25)g/L]was higher than that of group B [(4.17 ±0.39)g/L],and there was statistically significant (P<0.01).Conclusion Glutathione can reduce the incidence of ventilator-associated lung injury and prevent the occurrence of ventilator-associated lung injury.
RESUMO
Objective To investigate the effect of dexmedetomidine combined with butorphanol conventional therapy on sustaining sedation of intensive care unit (ICU) patients.Methods Sixty critically ill patients in Binzhou Central Hospital from June to September in 2014 were randomly divided into experimental group and control group, 30 cases in each group. In the control group, 0.8 mg/L dexmedetomidine hydrochloride injection (400μg with addition of 46 mL normal saline to form 50 mL solution) was intravenously infused continuously at a speed of 0.4μg·kg-1·h-1 by a micro-pump to induce analgesia and sedation; while in the experimental group, dexmedetomidine combined with 200 mg/L butorphanol (10 mg plus 40 mL normal saline to form 50 mL solution) was given for intravenous infusion by a micro-pump with a speed of 0.01 mg·kg-1·h-1 to maintain analgesia and sedation for 48 hours whose required Ramsay score in both groups was 3 - 5. Before and after treatment, the changes of heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and the pulse oxygen saturation (SpO2) of both groups were observed. The dosage of dexmedetomidine used for maintenance of required analgesia and sedation and FPS (facial expression) grading and Ramsay score were compared respectively between the two groups, and the clinical efficacy of the two groups were evaluated.Results After treatment, the HR, MAP, RR in both groups were significantly lower, and PaO2 and SpO2 were significantly higher than those before treatment, and the degrees of improvement in the above indexes of the experiment group were superior to those of the control group [HR (bpm): 84.58±12.43 vs. 118.62±14.21, MAP (mmHg, 1 mmHg = 0.133 kPa): 82.35±12.12 vs. 92.35±12.32, RR (times/min): 25.42±3.98 vs. 32.87±5.12, PaO2 (mmHg): 95.21±10.55 vs. 75.18±8.57, SpO2: 0.981 4±0.102 8 vs. 0.954 7±0.093 8, allP < 0.05]. The total therapeutic effect in experiment group was significantly higher than that in control group [93.3% (28/30) vs. 76.7% (22/30),P < 0.05]. The dexmedetomidine dosage used in the experiment group was much less than that in the control group (μg/d: 412.12±23.18 vs. 520.05±15.68,P < 0.05). The FPS score in the experiment group was obviously lower than that in the control group (1.48±0.16 vs. 2.52±0.74,P < 0.05).Conclusion In comparison, to achieve sustained and required analgesic and sedative effect for ICU patients by combined use of dexmedetomidine and butorphanol, the dosage of dexmedetomidine used is less than dexmedetomidine applied alone, in addition, the combined use can achieve better Ramsay grading, steady blood pressure and excellent effect.
