纳洛酮联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床研究

Clinical trial of naloxone combined with noninvasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease and respiratory failure

目的观察纳洛酮联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效及安全性。方法将86例慢性阻塞性肺疾病合并呼吸衰竭患者随机分为对照组43例和试验组43例。对照组予以无创正压通气治疗,每次4h,tid;试验组在对照组治疗的基础上,予以静脉注射纳洛酮,首剂0.8 mg,15 min后,将纳洛酮2 mg在24 h内持续静脉泵入,连用3 d。2组患者疗程均为1周。比较2组患者的临床疗效、血气指标的变化情况,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为93.02%(40/43例)和74.42%(32/43例),差异有统计学意义(P<0.05)。治疗后,试验组与对照组的血氧分压分别为(85.16±7.43),(75.07±7.27)mm Hg;血氧饱和度分别为(93.67±1.86)%,(85.05±1.62)%;p H值分别为(7.42±0.15),(7.29±0.13);二氧化碳分压分别为(39.19±3.81),(48.05±6.28)mm Hg,差异有统计学意义(P<0.05)。2组患者的药物不良反应主要为发热和呼吸抑制,试验组和对照组的药物不良反应发生率分别为4.65%和6.98%,差异无统计学意义(P>0.05)。结论纳洛酮联合无创正压通气治疗可显著提高慢性阻塞性肺疾病合并呼吸衰竭患者的临床效果,有效地改善患者的血气指标,且不增加药物不良反应的发生率。

Objective To observe the clinical efficacy and safety of naloxone combined with noninvasive positive pressure ventilation （NPPV） in the treatment of chronic obstructive pulmonary disease （COPD） and respiratory failure. Methods Eighty - six patients with COPD and respiratory failure were randomly divided into control group （ n = 43） and treatment group （ n = 43 ）. Control group was treated with NPPV （S/T ventilation） tid with 4 h per time. Treatment group was received with naloxone, the first dose was 0. 8 mg, intravenous injection. After 15 min, continuous intravenous infusion of naloxone 2 mg by the micro pump in 24 h, for 3 d. The course of two groups was one week. The clinical efficacy, changes in blood gases and incidence of adverse drug reactions were compared between the two groups. Results After treatment, the total effective rate of treatment and control groups were 93.02% （ 40/43 ） and 74. 42% （ 32/43 ） with significant difference （P 〈 0. 05 ）. After treatment, the main indexes in treatment and control groups were observed ： the oxygen tension （ PaO2 （ SaO2 ） were （93.67 ±1.86） %, （85.05 ± 1.62） （PaC02） were （39. 19±3.81）, （48.05 ±6.28） ） were （ 85. 16±7.43 ）, （75.07 ± 7. 27 ） mmHg; oxygen saturation % ; pH value were （7.42 ±0. 15） and （7. 29 ±0. 13） ; carbon dioxide mmHg, with statistically significant difference （P 〈0. 05）. The main adverse drug reactions were fever and respiratory depression in two groups, and there was no statistically significant difference on the incidence of adverse drug reactions in treatment and control groups （4. 65% vs 6. 98%, P 〉0. 05）. Conclusion Naloxone combined with NIPPV have a definitive clinical efficacy for the treatment of COPD and respiratory failure, which can improve the blood gases, without increasing the incidence of adverse drug reactions.