纳洛酮治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭患者临床疗效研究

Study Clinical Curative Effect in Patients with Chronic Obstructive Pulmonary Disease Complicated with Type Ⅱ Respiratory Failure after Naloxone Treatment

目的:探讨纳洛酮治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭患者血清降钙素原、炎症因子的改变及临床疗效。方法:收集2013年5月至2014年9月来我院治疗的COPD合并Ⅱ型呼吸衰竭患者60例,根据治疗方法不同随机分为对照组和观察组,对照组给与常规治疗,观察组在常规治疗的基础上给与纳洛酮治疗。记录两组患者在治疗前后静脉血Pa CO2、Pa O2的变化以及临床疗效。采用Elisa法检测两组患者在治疗前后血清PCT、TNF-α、IL-6含量的变化,并用RT-PCR法检测两组患者在治疗前后血清PCT、TNF-α、IL-6 DNA的改变。结果:观察组患者在治疗前静脉血Pa CO2的值为81.3±9.4 mm Hg,治疗后下降为45.4±5.3mm Hg,Pa O2由49.6±3.9 mm Hg上升至81.3±5.9 mm Hg,均优于对照组,与对照组比较差异有统计学意义(P<0.05);临床总有效率为85.7%,高于对照组的68%,且差异有统计学意义(P<0.05)。ELISA检测结果显示,两组患者在治疗后,血清PCT,CRP、IL-6含量均显著下降,且观察组下降程度高于对照组,RT-PCR检测结果与ELISA检测结果相一致。结论:纳洛酮治疗COPD合并Ⅱ型呼吸衰竭的临床疗效显著,能有效的提高Pa O2,降低Pa CO2,且能有效的减缓炎症反应的加重。

Objective： To investigate the changes of procalcitonin, serum inflammatory factors and clinical curative effect in patients with chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure after naloxone treatment. Methods： 60 patients with COPD and type Ⅱ respiratory failure who were treated in our hospital from May 2010 to May 2014 were selected and randomly divided into the observation group and the control group according to the different methods. The patients in the control group were treated with the conventional method, while the patients in the observation group were treated with the naloxone besides of the conventional method. Then the changes of Pa CO2 and Pa O2 in the venous blood of patients in the two groups were observed and compared before and after the treatment. The ELISA method was used to detect the changes of PCT, TNF-α and IL-6 in serum, and the RT-PCR method was used to detect the changes of PCT, TNF-α and IL-6 in terms of DNA of patients in the two groups before and after the treatment. Results： The observation group patients before treatment of venous blood Pa CO2 value of 81.3 ±9.4 mm Hg, and decreased after the treatment was 45.4±5.3 mm Hg, Pa O2 increased from 49.6±3.9 mm Hg to 81.3±5.9 mm Hg, were better than the control group,there was statistically significant difference compared with the control group（P〈0.05）; The clinical total effective rate was 85.7%, higher than the 68% in the control group, and the difference was statistically significant（P〈0.05）. ELISA test results showed that the patients in the two groups after treatment, serum PCT, CRP, IL-6 content decreased significantly, and the observation group decreased significantly higher than that of control group, RT-PCR results were consistent with the ELISA detection. Conclusion： The curative effect of naloxone in the treatment of COPD with type Ⅱ respiratory failure was significant, which could effectively improve the Pa O2, reduced Pa CO2, and could effectively reduce the inflammation reaction.