copd患者的鎮(zhèn)靜問題

COPD患者應(yīng)慎重應(yīng)用鎮(zhèn)靜1.1、COPD的鎮(zhèn)靜催眠問題；2、長期口服鎮(zhèn)靜催眠藥物的呼吸不良事件；3、短期靜脈應(yīng)用鎮(zhèn)靜的心肺問題；4、無創(chuàng)輔助通氣時應(yīng)用鎮(zhèn)靜的問題2.COPD與睡眠3.1、Upto50%oftheirpatientswithCOPDexperiencesleepabnormalities【1】.Dyspnea；coughandexcessivemucus；thesupineposition；ventilatoreffort；nocturnaldesaturationsandhypercapnicepisodes；drugs2、Sleep-relatedcomplaintsarerankedthirdcomplaintsofpatientswithCOPD【2】.1、StegeG,VosPJ,vandenElshoutFJ,RichardDPN,vandeVenMJ,HeijdraYF.Sleep,hypnoticsandchronicobstructivepulmonarydisease.RespirMed.2008.102(6):801-14.2、KinsmanRA,YaroushRA,FernandezE,DirksJF,SchocketM,FukuharaJ.Symptomsandexperiencesinchronicbronchitisandemphysema.Chest1983;83:755–61.4.sevenstudieswithpatientswithCOPDshowedadverserespiratoryeffectsassociatedwithNBBRAsandbenzodiazepines,wheresevenothersdidnot.moreadverseeffectswereseenwithlongeractingbenzodiazepines.5.Limitedduration.

varyingseverityofCOPD.

Differentpharmacodynamics

variousrespiratoryparameters

1、StegeG,VosPJ,vandenElshoutFJ,RichardDPN,vandeVenMJ,HeijdraYF.Sleep,hypnoticsandchronicobstructivepulmonarydisease.RespirMed.2008.102(6):801-14.

6.hypnotics,particularlybenzodiazepines,shouldbeavoided,ifpossibley,althoughthereisevidencethatsomehypnotics,suchaszolpidem,canbeusedinlesssevereCOPDwithoutsignificantadverseeffectsongasexchange1.1.CelliBR,MacNeeW.StandardsforthediagnosisandtreatmentofpatientswithCOPD:asummaryoftheATS/ERSpositionpaper.EurRespirJ2004;23:932–46.7.長期口服鎮(zhèn)靜催眠藥物的呼吸不良事件8.長期催眠藥物對慢性COPD患者的影響ChungWS,LaiCY,LinCL,KaoCH.AdverseRespiratoryEventsAssociatedWithHypnoticsUseinPatientsofChronicObstructivePulmonaryDisease:APopulation-BasedCase-ControlStudy.Medicine(Baltimore).2015.94(27):e1110.9.ChungWS,LaiCY,LinCL,KaoCH.AdverseRespiratoryEventsAssociatedWithHypnoticsUseinPatientsofChronicObstructivePulmonaryDisease:APopulation-BasedCase-ControlStudy.Medicine(Baltimore).2015.94(27):e1110.10.ChungWS,LaiCY,LinCL,KaoCH.AdverseRespiratoryEventsAssociatedWithHypnoticsUseinPatientsofChronicObstructivePulmonaryDisease:APopulation-BasedCase-ControlStudy.Medicine(Baltimore).2015.94(27):e1110.11.hypnotics,especiallyinactiveusers(0–30days),isassociatedwithanincreasedriskofadverserespiratoryeventsintheseCOPDpatients.ThisincreasedriskofadverserespiratoryeventsemphasizesthatevaluatingthecurrentinsomniatreatmentswithhypnoticsfortheseCOPDpatientsisnecessaryandimportant.CliniciansshouldkeepalertofthepotentialriskofadverserespiratoryeventsintheseCOPDpatientsbeforeprescribinghypnotics.ChungWS,LaiCY,LinCL,KaoCH.AdverseRespiratoryEventsAssociatedWithHypnoticsUseinPatientsofChronicObstructivePulmonaryDisease:APopulation-BasedCase-ControlStudy.Medicine(Baltimore).2015.94(27):e1110.12.COPD患者的短期臨床鎮(zhèn)靜13.短期鎮(zhèn)靜對高齡COPD患者心肺功能的影響XuCX,ChenX,JiaY,etal.Stepwisesedationforelderlypatientswithmild/moderateCOPDduringuppergastrointestinalendoscopy.WorldJGastroenterol.2013.19(29):4791-8.14.XuCX,ChenX,JiaY,etal.Stepwisesedationforelderlypatientswithmild/moderateCOPDduringuppergastrointestinalendoscopy.WorldJGastroenterol.2013.19(29):4791-8.15.XuCX,ChenX,JiaY,etal.Stepwisesedationforelderlypatientswithmild/moderateCOPDduringuppergastrointestinalendoscopy.WorldJGastroenterol.2013.19(29):4791-8.16.無創(chuàng)輔助通氣中的鎮(zhèn)靜問題17.18.19.XuCX,ChenX,JiaY,etal.Stepwisesedationforelderlypatientswithmild/moderateCOPDduringuppergastrointestinalendoscopy.WorldJGastroenterol.2013.19(29):4791-8.20.小結(jié)COPD患者普遍存在