纳美芬与纳洛酮联合无创呼吸机治疗COPD合并Ⅱ型呼吸衰竭临床效果观察

Clinical effects of nalmefene and naloxone combined with noninvasive ventilation in COPD patients with type II respiratory failure

目的评估新一代阿片受体拮抗剂纳美芬应用于慢性阻塞性肺疾病（chronicobstructive Dulmonarydiseases，COPD）合并Ⅱ型呼吸衰竭治疗中的作用。方法选择一汽总医院ICU科2008年1月～2014年5月收治的COPD合并II型呼吸衰竭患者86例纳入观察，随机分为ABc3组，A组患者予以常规药物治疗及无创呼吸机辅助通气。B组在上述治疗的基础上应用纳洛酮，C组在上述治疗的基础上应用纳美芬。观察3组患者治疗前及治疗48h后的血气指标，比较3组治疗的有效率。结果B组和C组治疗48h后的血气指标较A组改善明显（p〈0．05），C组P（A—a）O2较B组改善明显（P〈0．05）；B组和C组治疗有效率高于A组（P〈0．05），B组和C组治疗有效率差异无统计学意义（P〉0．05）。结论纳美芬与纳洛酮联合无创呼吸机辅助通气能改善患者的缺氧及二氧化碳潴留，降低气管插管率，纳美芬可能较纳洛酮更为安全有效。

Objective To evaluate the clinicaleffectsof nalmefene and naloxone combined with noninvasive ventilation in chronic obstructive pulmonary disease （COPD） patients with type Ⅱ respiratory failure. Methods 86 COPD patients with typeⅡ respiratory failure were randomLy divided into 3 groups： Group A （n=28） underegoing conventional anti-infection and antispasmodic treatment and noninvasive ventilation （NIV）, Group B （n=30） undergoing continuous micro-pump injection ofnaloxone 4-8 mg in 50 mL normal saline in addition to the above-mentioned conventional treatment and NIV, and Group C（n=28） undergoing Intravenous drip of nalmefene 1.0 mg qd in addition to the above-mentioned conventional treatment and NIV. Blood gas indexes were recorded before treatment and 48 hours after treatment. The clinical effects wer eobserved. Results The blood gas indexes 48 hours after treatment of Groups B and C were was improved much more compared with those of Group A （all P〈 0.05）, and the P（A-a）O2 of Group C was much more improved compared with that of Group B （ P〈 0.05）. Theeffective rates of Groups B and C were significantly higher than that of Group A （both P〈 0.05）, however, there was no statistical difference in he effective rate between Groups B and C （ P〉 0.05）. Conclusion Nalmefene and naloxone combined with NIV effectively correct hypoxemia and carbon dioxide retention, reduce the intubation rate, and nalmefene may be safer and more effective than naloxone.