纳洛酮治疗肺性脑病早期临床疗效观察

Observation of the Earlier period Clinical Effect of Naloxone in Treatment of Pulmonary Encephalopathy

目的观察评价纳洛酮治疗肺性脑病临床疗效及安全性。方法将纳入的肺性脑病患者76例随机分为观察组（n=38）及对照组（n=38），两组均予以积极控制感染，持续低流量吸氧，保持气道通畅，维持酸碱、水、电解质平衡，营养支持等综合治疗。观察组在此基础上加用纳洛酮注射剂，首剂负荷量0．8mg加入生理盐水20ml中静脉推注，静脉推注（时间不少于3min），2h 1次。神志开始转清醒时，改为每次0．4mg，3h 1次，共3次。用6次神志仍不转清者，视为无效。应放弃纳洛酮治疗。结果治疗后24h，观察组总有效率显著高于对照组（P〈0．05）；两组患者的PaO2均明显升高，PaCO2显著降低，pH值升高，与治疗前相比，差异有显著性意义（P〈0．05）；两组比较，PaO2有非常显著性意义（P〈0．05）。但PaCO2、pH的差异无显著性（P〉0．05）。结论纳洛酮可缩短血气改善时间。促进肺性脑病患者神志恢复。

Aim： To observe the clinical effect and safety ofnaloxone in treatment of pulmonary encephalopathy. Methods： 76 patients with pulmonary en-cephalopathy were randomly divided into 2 groups, treating group（ n=38 ）and control group （ n=38 ） .Two groups were received basic therapy including anti-infection, keep on low fluence oxygen supply, to keep air duct to be unobstructed, retain acid base, water and electrolyte balance, nutritional support, etc, combined therapy. On the base, the treating group were given naloxone.first loading dose 0.8mg mix into 20ml NS medium-sized vein bolus（ to last more than 3 min）, per 2 h once. When the patients turn to conscious, to Change 0.4 mg once, 3 h once, 3 times. IfstiU groggy when achieve 6 times, as such situation would be deemed invalid, shoud be give up Naloxone treatment. Results： After 24 h treatment, the total effective rate in the treat-ing group was significantly higher than that in the control group （ P〈0.05 ）.PaO2, pH in both groups were signifi-candy higher than before treatment（P〈0.05） ; PaCO2 were signifi-candy lower than before treatment（P〈0.05）.PaO2 in the treating group was signifi-cantly higher than that in the control group （ P〈0.05 ） .But, PaCO2, pH in two groups were not significantly contrast （ P〉0.05 ） . Conclusion： Naloxone can decurtate the time of blood gas amendment, to advance pulmonary encephalopathy turn to conscious.