比例辅助通气联合纳络酮治疗呼吸衰竭的疗效观察

The Clinical Observation of PAV United Naloxone Treatment in Respiratory Failure

目的观察比例辅助通气(PAV)联合纳络酮治疗呼吸衰竭的临床疗效。方法选择2008年2月至2010年1月在河北省张家口市第一医院呼吸科收治住院的呼吸衰竭患者96例,将患者随机分为观察组和对照组各48例。2组患者入院后均予以吸氧、抗感染、解痉平咳、化痰、纠正电解质和酸碱平衡紊乱及呼吸兴奋剂等常规治疗。对照组在常规治疗基础上加用美国伟康的bipap_vision无创呼吸机,先予S/T模式通气,待呼吸平稳后转入PAV模式通气,患者能稳定自主呼吸,达到临床撤机标准时,考虑撤机。观察组在对照组治疗基础加用纳洛酮2mg,加入0.9%氯化钠溶液50ml输液泵推注,维持5h,1次/d。结果观察组总有效率89.6%明显优于对照组72.9%(P<0.05);治疗后观察组呼吸频率(19±6)、心率(93±12)及动脉血气(pH值:7.33±0.12、PaO2:8.7±1.4、PaCO2:7.0±0.8)变化均明显优于对照组(呼吸频率:22±6、心率:99±14、pH值:7.28±0.10、PaO2:8.1±1.3、PaCO2:7.5±1.1),差异均有统计学意义(P<0.05,或P<0.01)。结论 PAV在呼吸衰竭患者中能提供良好的呼吸支持,联合纳络酮,能够更显著的改善呼吸循环功能,提高抢救成功率,提高临床疗效。

Objective To observe the clinical curative effect of proportion of assisted ventilation （PAV） combined with naloxone treatment in respiratory failure. Methods 96 patients of chronic obstructive pulmonary disease who had a diagnosis and were given treatment in The First Hospital in Zhangjiakou of Hebei province between February 2008-January 2010 were divided into the Observer Group and the control group randomly.each of them had 48 cases. Every group took the oxygen uptake anti-infection facilitating expectoration and suppressing cough and relieving dyspnea and correcting electrolyte and acid-base balance disorders. The control group used the bipap-vision noninvasive ventilator except the routine treatmen. Choose S/T mode. Changed the mode to PAV when Spontaneous breathing in patients stably,Observation group based on the control group plused naloxone 2 mg,0.9% NaCl solution 50ml bloused by infusion pump,Maintained 5 h,1 times/d. Results The total effective in observation group was 89.6% higher than the control group 72.9% （P0.05）;Respiratory rate after treatment group （19±6）,Heart rate （93±12） and arterial blood gas （pH value：7.33 ± 0.12,PaO2：8.7 ± 1.4,PaCO2：7.0 ± 0.8）,Changes were significantly better than the control group （respiratory rate：22 ± 6,Heart rate：99 ± 14,pH value：7.28 ± 0.10,PaO2：8.1±1.3,PaCO2：7.5±1）,Differences were statistically significant（P0.05,or P0.01）.Conclusion PAV in patients with respiratory failure can provide good respiratory support. Combine with Naloxone have more significant improvement in respiratory and circulatory functions,It can Improve the success rate and the clinical curative effect.