BiPAP正压无创辅助通气联合盐酸纳洛酮在慢性阻塞性肺疾病急性加重期治疗中的应用效果

Effects of BiPAP non-invasive assisted ventilation combined with naloxone hydrochloride in patients with acute exacerbation of chronic obstructive pulmonary disease

目的 探讨双相气道内正压（BiPAP）无创辅助通气联合盐酸纳洛酮在重症医学科慢性阻塞性肺疾病（COPD）急性加重期（AECOPD）患者治疗中的应用效果.方法 将医院2015年6月至2017年6月重症医学科接诊的105例AECOPD患者随机分为A组（53例）和B组（52例）,A、B组均给予BiPAP无创通气等基础治疗,A组在此基础上加用盐酸纳洛酮注射液治疗,比较A、B组rSO2、肺功能及血清炎症因子水平.结果 A、B组治疗后rSO2、动脉血氧饱和度（SpO2）、第1秒用力呼气容积占预计值百分比（FEV1％）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）升高（P〈0.05）,血清巨噬细胞炎症蛋白1-α（MIP-1α）、γ-干扰素（IFN-γ）、白细胞介素-17（IL-17）水平下降（P〈0.05）,A组rSO2、SpO2、肺功能指标及血清炎症因子变化幅度大于B组（P〈0.05）;FEV1％Pred、FEV1/FVC与rSO2、SpO2呈正相关（P〈0.05）,FEV1％Pred、FEV1/FVC与血清MIP-1α、IFN-γ、IL-17水平呈负相关（P〈0.05）.结论 BiPAP无创辅助通气联合盐酸纳洛酮治疗可改善重症医学科AECOPD患者气流受限,提高rSO2和SpO2,下调血清炎症因子水平,从而控制患者病情.

Objective To investigate the effects of biphasic positive airway pressure （BiPAP） non-invasive assisted ventilation combined with naloxone hydrochloride in patients with acute exacerbation of chronic obstructive pulmonary disease （COPD） in intensive care unit. Methods A total of 105 cases with AECOPD admitted to intensive care unit of hospital from June 2015 to June 2017 were randomly di- vided into group A （n =53） and group B （n =52）. Both groups were given BiPAP noninvasive ventilation and other basic treatment, and group A was additionally given naloxone hydrochloride injection. The rSO2, pulmonary function and serum levels of inflammatory factors were compared between the two groups. Results After treatment, the levels of rSO2, arterial oxygen saturation （ SpO2 ） , percentage of forced expiratory volume in one second of predicted value （ FEV1% ） and forced expiratory volume in the first second/forced vital capacity （FEV1/FVC） were significantly increased in the two groups （P 〈 0.05 ） while serum levels of MIP-1α, IFN-γ/and IL-17 were significantly decreased （P 〈 0. 05 ） , and the changes of rSO2, SpO2, pulmonary function indexes and serum inflammatory factors in group A were higher than those in group B （P 〈 0. 05 ）. The FEV1% Pred and FEV1/FVC were positively correlated with rSO2 and SpO2 （P 〈 0. 05 ） while were negatively correlated with serum MIP-1α and IFN-γ （P 〈 0. 05）. Conclusions BiPAP non-invasive assisted ventilation combined with naloxone hydrochloride can improve airflow limitation, rSO2 and SpO2, and decrease serum levels of inflammatory factors in AECOPD patients in intensive care unit, thereby controlling the patient＇s condition.