无创呼吸机联合纳洛酮治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的疗效观察

Therapeutic effect of noninvasive ventilation combined with naloxone for treating chronic obstructive pulmonary disease with acute exacerbation combined with type Ⅱ respiratory failure

目的观察使用无创呼吸机联合纳洛酮治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者的临床效果。方法选择2013年1月-2015年12月南通大学附属海安医院呼吸内科收治的.AECOPD合并Ⅱ型呼吸衰竭患者90例作为研究对象,按治疗方法分为观察组(n=52)和对照组(n=38);对照组给予常规治疗,观察组在其基础上给予无创呼吸机联合纳洛酮治疗,观察2组的临床疗效及血气指标的变化,并随访记录不良反应。结果观察组总有效率显著高于对照组(98.1%vs.79.0%,x^2=8.927,P=0.003);治疗后观察组患者在呼吸频率、心率、FEV_1/FVC%和呼吸困难评分等临床症状改善程度均显著优于对照组(t=6.668、6.272、6.192、6.597,P<0.05);观察组的SpO_2、PaO_2、PaCO_2、pH等血气分析指标改善程度显著优于对照组(t=6.616、6.931、6.315、6.219,P<0.05);观察组随访的气管插管率和6个月内急性加重率显著低于对照组(x^2=6.583、6.467,P<0.05);2组患者不良反应发生情况比较,差异无统计学意义(x^2=1.134,P=0.102)。结论使用无创呼吸机联合纳洛酮治疗AECOPD合并Ⅱ型呼吸衰竭患者,能显著改善患者的临床症状、活动耐力和心肺功能,提高患者的生活质量,降低有创呼吸机使用率和减少急性发作频率,安全性较高,值得在临床上推广和应用。

Objective To investigate the efficacy and clinical experience of using noninvasive ventilation combined with naloxone for treating chronic obstructive pulmonary disease （ AECOPD） with acute exacerbation combined with type Ⅱre-spiratory failure.Methods From January 2013 to December 2015, in People Hospital of Hai ’ an County, 90 patients with AECOPD combined with type Ⅱrespiratory failure were chosen as research subjects , according to the method of treatment , they were randomized into observation group （ n =52 ） and control group （ n =38 ）; control group received conventional treatment , observation group received noninvasive ventilation on its basis combined with naloxone treatment , then observing ef-ficacy and clinical experience .Results The total effective rate in the observation group was significantly higher than that in the control group （98.1% vs.79.0%,χ2 =8.927, P =0.003）.After treatment, the degree of improvement of clinical symptoms such as respiratory rate , heart rate, FEV1/FVC% and dyspnea score was much better than control group （ t =6.668, t =6.272, t =6.192, t =6.597, all P 〈0.05）.The degree of blood analysis index improvement of SPO 2,PaO2, PaCO2 , pH in observation group was significantly better than that in the control group （ t =6.616, t =6.931, t =6.315, t =6.219,all P 〈0.05）.The tracheal intubation rate and the exacerbation rate within 6 months were significantly lower in obser-vation group than that in control group （χ2 =6.583,χ2 =6.467, all P 〈0.05）.There was no significant difference in the in-cidence of adverse reactions between two groups （χ2 =1.134, P =0.102）.Conclusion Using noninvasive ventilator joint naloxone to treat AECOPD patients with type Ⅱrespiratory failure can significantly improve the clinical symptoms , activity tol-erance and heart and lung function , improve the quality of patients ’ lives and reduce the invasive ventilator utilization and re-duce the frequency of exacerbation .It is of high security , and worthy of promotion and application in clinical practice .