清开灵注射液联合纳洛酮辅助治疗慢性阻塞性肺疾病合并肺性脑病的临床观察

Clinical Observation of Qingkailing Injection Combined with Naloxone in the Adjuvant Treatment of Chronic Obstructive Pulmonary Disease with Pulmonary Encephalopathy

目的：观察清开灵注射液联合纳洛酮辅助治疗慢性阻塞性肺疾病（COPD）合并肺性脑病的临床疗效和安全性。方法：80例COPD合并肺性脑病患者随机均分为对照组和观察组。对照组患者给予双水平无创正压通气、常规吸氧、抗感染、化痰平喘等常规治疗;观察组患者在对照组治疗的基础上给予清开灵注射液40~60ml,静脉滴注,30~40滴/min,qd＋注射用盐酸纳络酮0.8mg,静脉注射,后再给予注射用盐酸纳络酮2mg,连续24h微量泵入。两组患者均连续给药3d。观察两组患者的临床疗效,治疗前后动脉血氧分压（pO2）、二氧化碳分压（pCO2）、酸碱度（pH）、心排出量（CO）、心脏指数（CI）、格拉斯哥昏迷（GCS）评分、平均住院时间、气管插管率及不良反应发生率。结果：观察组患者总有效率显著高于对照组,平均住院时间、不良反应发生率显著低于对照组,差异均有统计学意义（P〈0.05）。治疗后,两组患者pO2、pH、GCS评分均显著高于同组治疗前,且观察组高于对照组,pCO2显著低于同组治疗前,且观察组低于对照组,差异均有统计学意义（P〈0.05）;两组患者治疗前后CO、CI及气管插管率比较,差异均无统计学意义（P〉0.05）。结论：在常规治疗的基础上,清开灵注射液联合纳洛酮治疗COPD合并肺性脑病疗效和安全性均较好。

OBJECTIVE ： To observe the clinical efficacy and safety of Qingkailing injection combined with naloxone in the adjuvant treatment of chronic obstructive pulmonary disease （COPD） with pulmonary encephalopathy. METHODS： 80 COPD patients with pulmonary encephalopathy were randomly divided into control group and observation group. Control group was treated with conventional treatment, including bi-level noninvasive positive pressure ventilation, conventional oxygen inhalation, anti-infection, resolving sputum and relieving asthma, etc ; based on the treatment of control group, observation group was additionally treated with Qingkailing injection 40-60 ml by intravenous infusion, 30-40 drops/min, qd＋Naloxone hydrochloride injection 0.8 mg by intravenous infusion, anu then Naloxone hydrochloride injection 2 mg by microinfusion pump for continuous 24 h. After 3 d, the clinic data was observed, including clinical efficacy, and pO2,pCO~, pH, CO,- CI, GCS coma score before and after treatment, average hospitalization time, endotracheal intubation rate and incidence of adverse reactions. RESULTS： The total effective rate in observation group was significantly higher than control group, average hospitalization time and incidence of adverse reactions were significantly lower than control group（P〈0.05）. After treatment, pO2, pH and GCS scores in 2 groups were significantly higher than before, observation group was higher than control group, pCO2 was significantly lower than before, observation group was lower than control group（P〈0.05）. There were no significant differences in the CO and CI before and after treatment and endotra- cheal intubation rate between 2 groups （P〉0.05）. CONCLUSIONS： Based on the conventional treatment, Qingkailing injection combined with naloxone has good efficacy and safety in the adjuvant treatment of COPD with pulmonary encephalopathy.