无创正压通气联合纳洛酮治疗慢性阻塞性肺疾病急性发作合并肺性脑病的临床研究

A randomized control trial of noninvasive positive pressure ventilation combined with naloxone in the treatment of acute exacerbations of chronic obstructive pulmonary diseases with pulmonary encephalopathy

目的观察无创正压通气(NPPV)联合纳洛酮治疗慢性阻塞性肺疾病急性发作(AECOPD)合并肺性脑病的疗效。方法将AECOPD合并肺性脑病的患者78例随机分成2组,观察组39例,在综合治疗的基础上,采用NPPV联合纳洛酮治疗;对照组39例,除不用纳洛酮外,其他治疗同观察组。观察2组抢救成功率和失败率,并比较治疗前及治疗后3 d呼吸频率(RR)、心率(HR)、指脉氧饱和度(SpO_2)、呼气末二氧化碳分压(P_(ET)CO_2)及动脉血气指标的变化。结果(1)观察组总抢救成功率(92.3%)虽较对照组(84.6%)高,但2组比较差异无统计学意义(P>0.05);(2)与治疗前比较,2组治疗3 d后RR、HR均改善(P<0.01),2组治疗后比较差异无统计学意义(P>0.05)。呼吸困难程度评分治疗前与治疗后比较:观察组[(1.70±0.61)分vs.(2.78±0.64)分]、对照组[(1.72±0.58)分vs.(2.44±0.33)分]均改善明显(P<0.05),2组治疗后比较差异有统计学意义(P<0.05)。(3)与治疗前比较,治疗3 d后观察组pH、SaO_2、PaO_2、PaCO_2、SpO_2、P_(ET)CO_2均改善,对照组除SpO_2外,其余指标亦改善(P<0.05或P<0.01)。2组pH、PaCO_2、P_(ET)CO_2比较差异有统计学意义(P<0.01)。结论 NPPV治疗AECOPD合并肺性脑病具有较好的疗效,及早联用呼吸兴奋剂纳洛酮,可提高治疗效果,提高抢救成功率,降低气管插管率和病死率。

Objective To observe the therapeutic effect of noninvasive positive pressure ventilation （NPPV） com- bined with naloxone in treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with pulmonary encephalopathy. Methods Seventy-eight cases of AECOPD patients with pulmonary encephalopathy were randomly divided into 2 groups, 39 cases in observation group, on the basis of comprehensive therapy, using NPPV combined with nal- oxone in treatment; 39 cases in the control group, without naloxone, other treatment was same as the observation group. The 2 groups were observed the success rate and failure rate, and 3 d respiratory frequency （ RR）, heart rate （ HR）, pulse oxygen saturation （SpO2）, end tidal carbon dioxide partial pressure （PETCO2） and changes of arterial blood gas indexes were com- pared before and after treatment. Results （ 1 ） Observation group＇s total success rate （92.3%） is higher than the control group （84.6%）, but no significant differences between the 2 groups were found （ P 〉 0.05 ） ; （2） Compared with before treatment, after 3 day treatment, RR and HR were improved in both of the 2 groups （ P 〈 0.01 ）, no significant difference were found between the 2 groups （ P 〉 0.05 ）. Comparison of respiratory score of before treatment and after treatment, both of the observation group [（1.70 ± 0.61） vs. （2.78 ±0.64）] and the control group [（1.72± 0.58） vs. （2.44 ±0.33） ] were improved significantly （ P 〈 0.05）, after treatment, there were significant difference between the 2 groups （P 〈 0.05）. （3） Compared with before treatment, after 3 days treatment, observation group＇s pH, Sa02, PaO2, PaCO~, SpO2, PETCO2 group were improved; in the control group, except SpO2, other indicators also improved （P 〈 0.05, P 〈 0.01 ）. pH,PaCO2 ,PETCO2 were significant differences between the 2 groups （ P 〈 O. O1 ）. Conclusion The NPPV in treat- ment of AECOPD with pulmonary encephalopathy has good effect;early naloxone combined with respiratory stimulant can sig- nificantly improve the therapeutic effect, improve the success rate, and reduce the rate of endotracheal intubation and mortality.