NPPV联合纳洛酮治疗AECOPD合并重度呼吸衰竭疗效及对患者血清炎症因子血栓相关指标的影响

Efficacy of NPPV combined with naloxone in the treatment of AECOPD complicated with severe respiratory failure and its effect on serum inflammatory factors and thrombus-related indicators

目的探讨无创正压通气联合纳洛酮治疗慢性阻塞性肺疾病急性加重期合并重度呼吸衰竭的临床疗效及对患者血清相关指标的影响。方法将76例慢性阻塞性肺疾病急性加重期合并重度呼吸衰竭患者按随机数表法分为观察组和对照组,每组38例。两组均采用常规抗感染等综合治疗及无创正压通气治疗,观察组在此基础上联合纳洛酮治疗。比较两组治疗效果(治疗失败率、死亡率、住院时间),于治疗前及治疗第3 d末检测分析患者肺功能(第1秒最大呼气容积、用力肺活量、第1秒最大呼气容积/用力肺活量)、动脉血气指标(氧分压、二氧化碳分压、酸碱度)、血清炎症因子(降钙素原、肿瘤坏死因子α、C反应蛋白、血清和肽素)、血栓相关指标(血清肾上腺髓质素、D-二聚体、内皮素-1)。结果观察组住院时间显著短于对照组(P<0.05),两组治疗失败率、死亡率比较差异无统计学意义(P>0.05)。治疗第3 d末,观察组第1秒最大呼气容积、用力肺活量、第1秒最大呼气容积/用力肺活量显著大于对照组(P<0.05),氧分压、酸碱度值均显著高于对照组(P<0.05),二氧化碳分压、降钙素原、肿瘤坏死因子α、C反应蛋白、血清和肽素、肾上腺髓质素、D-二聚体、内皮素-1水平显著低于对照组(P<0.05)。结论无创正压通气联合纳洛酮治疗慢性阻塞性肺疾病急性加重期合并重度呼吸衰竭有利于改善患者动脉血气、肺功能等,控制机体炎症反应和高血凝状态,缩短治疗时间。

Objective To explore the clinical efficacy of non-invasive positive pressure ventilation(NPPV)combined with naloxone in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with severe respiratory failure and its effect on the relevant serum indicators of patients.Methods A total of 76 patients with AECOPD and severe respiratory failure were selected and divided into observation group and control group by random number table method,with 38 cases in each group.Both groups were treated with conventional anti-infection and noninvasive positive pressure ventilation(NPPV),the observation group was combined with naloxone therapy on the basis of the control group.Compare the treatment effects of the two groups(treatment failure rate,mortality rate,length of hospital stay)of the two groups.Detect and analyze the patient’s lung function[forced expiratory volume in one second(FEV1),forced vital capacity(FVC),FEV1/FVC],arterial blood gas indicators[oxygen partial pressure(PaO 2),carbon dioxide partial pressure(PaCO 2),potential of hydrogen(pH)],serum inflammatory factors[procalcitonin,tumor necrosis factor-α(TNF-α),c-reactive protein(CRP),copeptin(CPP)],and thrombus-related indicators[serum adrenomedullin(ADM),D-dimer,endothelin-1(ET-1)]before treatment and at the end of the third day of treatment.Results The hospital stay in observation group was shorter than that in control group(P<0.05).There were no significant differences in treatment failure rate and mortality rate between the two groups(P>0.05).After 3 d of treatment,the FEV1,FVC and FEV1/FVC in observation group were higher than those of the control group(P<0.05).The oxygen partial pressure and pH value were significantly higher than those of the control group(P<0.05),and the levels of PaCO 2,procalcitonin,TNF-α,CRP,serum CPP,ADM,D-dimer,and ET-1 were significantly lower than those of the control Group(P<0.05).Conclusions NPPV combined with naloxone for AECOPD with respiratory failure is beneficial to improve the arterial blood gas and lung function,control the body's inflammatory response and hypercoagulable state,shorten the treatment time.