1、COPD患者应慎重应用镇静,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,COPD与睡眠,1、Up to 50% of their patients with COPD experience sleep abnormalities【1】.Dyspnea；cough and excessive mucus；the supine position；ventilator effort；nocturnal desaturations and hypercapnic episodes；drugs2、Sleep-rel
2、ated complaints are ranked third complaints of patients with COPD【2】.1、Stege G, Vos PJ, van den Elshout FJ, Richard DPN, van de 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
3、,Fukuhara J. Symptoms and experiences in chronic bronchitis and emphysema. Chest 1983;83:75561.,seven studies with patients with COPD showed adverse respiratory effects associated with NBBRAs and benzodiazepines, where seven others did not.more adverse effects were seen with longer acting benzodiaze
4、pines.,Limited duration.varying severity of COPD.Different pharmacodynamicsvarious respiratory parameters1、Stege G, Vos PJ, van den Elshout FJ, Richard DPN, van de Ven MJ, Heijdra YF. Sleep, hypnotics and chronic obstructive pulmonary disease. Respir Med. 2008. 102(6): 801-14.,hypnotics, particularl
5、y benzodiazepines, should be avoided, if possibley,although there is evidence that some 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
6、 the ATS/ERS position paper. Eur Respir J 2004;23:93246.,长期口服镇静催眠药物的呼吸不良事件,长期 催眠药物对慢性COPD患者的影响,Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chronic Obstructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore).
7、 2015. 94(27): e1110.,Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chronic Obstructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore). 2015. 94(27): e1110.,Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respirato
8、ry Events Associated With Hypnotics Use in Patients of Chronic Obstructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore). 2015. 94(27): e1110.,hypnotics, especially in active users (030 days), is associated with an increased risk of adverse respiratory events in thes
9、e 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. Clinicians should keep alert of the potential risk of adverse respiratory events in these COPD patients bef
10、ore prescribing hypnotics.,Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chronic Obstructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore). 2015. 94(27): e1110.,COPD患者的短期临床镇静,短期镇静对高龄COPD患者心肺功能的影响,Xu CX, Chen
11、 X, Jia Y, et al. Stepwise sedation 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/moderate COPD during upper gastrointestinal endoscopy.
12、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 endoscopy. World J Gastroenterol. 2013. 19(29): 4791-8.,无创辅助通气中的镇静问题,Xu CX, Chen X, Jia Y, et al. Stepwise sedation for elderly patie
13、nts with mild/moderate COPD during upper gastrointestinal endoscopy. World J Gastroenterol. 2013. 19(29): 4791-8.,小结,COPD患者普遍存在有睡眠问题，提高生活质量指数可能会遇到镇静安眠问题；短期镇静治疗毋庸置疑可能会带来呼吸抑制及相关的低氧血症、低血压及相关心肺问题；COPD患者长期使用催眠镇静药物会增加其呼吸系统不良事件发生包括：肺炎、COPD急性加重、急性呼吸衰竭、及心肺骤停等。无创辅助通气中应用镇静是也应注意其会高碳酸血症的问题及其带来的致命风险。,观点,应用镇静安眠药物应慎重！,谢谢大家！,
