copd患者的鎮(zhèn)靜問題

1、COPD患者應(yīng)慎重應(yīng)用鎮(zhèn)靜,,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,,COPD與睡眠,1、Up to 50% of their patients with COPD experience sleep abnormalities【1】.Dyspnea；cough and excessive mucus；the supine pos

2、ition；ventilator effort；nocturnal desaturations and hypercapnic episodes；drugs2、Sleep-related complaints are ranked third complaints of patients with COPD【2】.1、Stege G, Vos PJ, van den Elshout FJ, Richard DPN, van d

3、e Ven MJ, Heijdra YF. Sleep, hypnotics and chronic obstructive pulmonary disease. Respir Med. 2008. 102(6): 801-14.2、Kinsman RA, Yaroush RA, Fernandez E, Dirks JF, Schocket M,Fukuhara J. Symptoms and experiences in chro

4、nic bronchitis and emphysema. Chest 1983;83:755–61.,seven studies with patients with COPD showed adverse respiratory effects associated with NBBRAs and benzodiazepines, where seven others did not.more adverse effects w

5、ere seen with longer acting benzodiazepines.,Limited duration.varying severity of COPD.Different pharmacodynamicsvarious respiratory parameters1、Stege G, Vos PJ, van den Elshout FJ, Richard DPN, van de Ve

6、n MJ, Heijdra YF. Sleep, hypnotics and chronic obstructive pulmonary disease. Respir Med. 2008. 102(6): 801-14.,hypnotics, particularly benzodiazepines, should be avoided, if possibley,although there is evidence that som

7、e hypnotics, such aszolpidem, can be used in less severe COPD without significant adverse effects on gas exchange1.1.Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of

8、the ATS/ERS position paper. Eur Respir J 2004;23:932–46.,長期口服鎮(zhèn)靜催眠藥物的呼吸不良事件,長期 催眠藥物對慢性COPD患者的影響,Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chronic Obstructive

9、 Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore). 2015. 94(27): e1110.,,Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chronic Obs

10、tructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore). 2015. 94(27): e1110.,,Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chr

11、onic Obstructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore). 2015. 94(27): e1110.,hypnotics, especially in active users (0–30 days), is associated with an increased risk of adverse res

12、piratory events in these COPD patients. This increased risk of adverse respiratory events emphasizes that evaluating the current insomnia treatments with hypnotics for these COPD patients is necessary and important.

13、Clinicians should keep alert of the potential risk of adverse respiratory events in these COPD patients before prescribing hypnotics.,Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics

14、 Use in Patients of Chronic Obstructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore). 2015. 94(27): e1110.,COPD患者的短期臨床鎮(zhèn)靜,短期鎮(zhèn)靜對高齡COPD患者心肺功能的影響,Xu CX, Chen X, Jia Y, et al. Stepwise sedati

15、on for elderly patients with mild/moderate COPD during upper gastrointestinal endoscopy. World J Gastroenterol. 2013. 19(29): 4791-8.,,Xu CX, Chen X, Jia Y, et al. Stepwise sedation for elderly patients with mild/moderat

16、e COPD during upper gastrointestinal endoscopy. World J Gastroenterol. 2013. 19(29): 4791-8.,,Xu CX, Chen X, Jia Y, et al. Stepwise sedation for elderly patients with mild/moderate COPD during upper gastrointestinal endo

17、scopy. World J Gastroenterol. 2013. 19(29): 4791-8.,無創(chuàng)輔助通氣中的鎮(zhèn)靜問題,,,,Xu CX, Chen X, Jia Y, et al. Stepwise sedation for elderly patients with mild/moderate COPD during upper gastrointestinal endoscopy. World J Gastroenter

18、ol. 2013. 19(29): 4791-8.,小結(jié),COPD患者普遍存在有睡眠問題，提高生活質(zhì)量指數(shù)可能會遇到鎮(zhèn)靜安眠問題；短期鎮(zhèn)靜治療毋庸置疑可能會帶來呼吸抑制及相關(guān)的低氧血癥、低血壓及相關(guān)心肺問題；COPD患者長期使用催眠鎮(zhèn)靜藥物會增加其呼吸系統(tǒng)不良事件發(fā)生包括：肺炎、COPD急性加重、急性呼吸衰竭、及心肺驟停等。無創(chuàng)輔助通氣中應(yīng)用鎮(zhèn)靜是也應(yīng)注意其會高碳酸血癥的問題及其帶來的致命風(fēng)險。,觀點(diǎn),應(yīng)用鎮(zhèn)靜安眠藥物應(yīng)慎重！,