copd患者的镇静问题

COPD患者应慎重应用镇静1.1、COPD的镇静催眠问题；2、长期口服镇静催眠药物的呼吸不良事件；3、短期静脉应用镇静的心肺问题；4、无创辅助通气时应用镇静的问题2.COPD与睡眠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.长期口服镇静催眠药物的呼吸不良事件8.长期催眠药物对慢性COPD患者的影响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患者的短期临床镇静13.短期镇静对高龄COPD患者心肺功能的影响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.无创辅助通气中的镇静问题17.18.19.XuCX,ChenX,JiaY,etal.Stepwisesedationforelderlypatientswithmild/moderateCOPDduringuppergastrointestinalendoscopy.WorldJGastroenterol.2013.19(29):4791-8.20.小结COPD患者普遍存在