双水平气道正压通气联合纳洛酮治疗慢性阻塞性肺病急性加重期并发Ⅱ型呼吸衰竭患者的疗效观察

Observation on the efficacy of bi-level positive airway pressure ventilation and naloxone for the treatment of chronic obstructive pulmonary disease in acute exacerbation combined with type Ⅱ respiratory failure

目的:探讨鼻面罩无创双水平气道正压通气(BiPAP)联用纳洛酮(NLX)治疗COPD急性加重期并发Ⅱ型呼吸衰竭的治疗效果。方法:将COPD急性加重期并发Ⅱ型呼吸衰竭患者78例随机分为观察组(38例)和对照组(40例),对照组采用吸氧、抗感染、化痰平喘等常规治疗,观察组除常规治疗外,还采用BiPAP通气联合NLX;比较两组治疗前后实验室指标和临床症状等的变化。结果:与治疗前相比,两组治疗后PaCO2降低、pH值上升、PaO2上升、SaO2增高(P<0.05)。两组治疗后心率、呼吸频率、血压均有显著改善(P<0.05)。与对照组比较,观察组治疗后各项指标改善较明显(P<0.05)。观察组住院时间缩短、气管插管率降低、病死率下降均较对照组明显,差异有统计学意义(P<0.05)。结论:BiPAP联合NLX治疗COPD急性加重期并发Ⅱ型呼吸衰竭患者疗效确切,插管率、病死率明显降低。

Objective： To discuss the efficacy of bi-level positive airway pressure ventilation （BiPAP） and naloxone for the treatment of chronic obstructive pulmonary disease （COPD） in acute exacerbation combined with type II respiratory failure. Methods： Thirty-eight cases with COPD in acute exacerbation and type II respiratory failure were treated with BiPAP combined with naloxone on the basis of conventional treatment; 40 cases in control group were treated with oxygen inhalation, anti-infection and so on. PH, PaO2, PaCO2 and SaO： before and after treat- ment in two groups were compared, and the change of HR, RR, MAP and clinical symptoms were observed. The hospitalization time, intubation rate and mortality rate were also observed. Results： After treatment, PaCO2 was obviously decreased in two groups, whereas pH, PaO2 and SaO2 were obviously increased. There were significant difference before and after treatment （ P 〈 0. 05 ）, HR, RR and blood pressure were obviously improved after treatment, the difference had statistical significance （P 〈 0.05 ）. The improvement of each index in observation group was obviously higher than that in control group after treatment, the difference had statistical significance （ P 〈 0. 05 ）. Compared with control group, observation group had shorter hospitalization time, lower intubation rate and mortality rate. The difference was obvious and had statistical significance （ P 〈 0. 05 ）. Conclusion： The treatment of COPD in acute exacerbation combined with type II respiratory failure by BiPAP and naloxone has obvious cura- tive effect. It can obviously decrease the intubation rate and mortality rate, which is worth of spreading in clinic.