纳洛酮联合无创呼吸机正压通气在COPD合并肺性脑病抢救中的应用

Application of naloxone combined with noninvasive positive pressure ventilation in the rescue of COPD complicated with pulmonary encephalopathy

目的研究纳洛酮联合无创呼吸机正压通气(BiPAP)对慢性阻塞性肺疾病(COPD)合并肺性脑病患者的抢救效果。方法选取高州市人民医院2018年8月1日至2020年8月1日期间收治的50例COPD合并肺性脑病患者作为研究对象,按照随机数表法分为研究组和对照组各25例。两组患者均进行常规治疗,对照组在常规治疗的基础上采用BiPAP治疗,研究组在对照组治疗的基础上采用纳洛酮治疗。治疗前后,检测两组患者动脉血气二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、pH值和格拉斯哥昏迷(GCS)评分及治疗后患者意识障碍改善时间、意识障碍消失时间、无创通气时间、住院时间等相关指标,同时比较两组患者的临床疗效、不良反应总发生情况。结果研究组患者的治疗总有效率为96.0%,明显高于对照组的80.0%,差异有统计学意义(P<0.05);治疗前,两组患者的PaCO_(2)、PaO_(2)、pH值比较差异均无统计学意义(P>0.05),治疗后,两组患者的PaCO_(2)值明显降低,PaO_(2)、pH值明显提高,且研究组患者的PaCO_(2)值为(42.7±1.6)mmHg,明显低于对照组的(49.3±1.9)mmHg,PaO_(2)、pH值分别为(73.7±3.4)mmHg、8.1±0.6,明显高于对照组的(64.2±3.1)mmHg、7.7±0.5,差异均有统计学意义(P<0.05);治疗后,研究组患者意识障碍改善时间、意识障碍消失时间、无创通气时间、住院时间分别为(6.2±2.1)h、13.6±4.1、(6.1±1.4)d、(11.5±3.2)d,明显短于对照组的(9.4±3.5)h、22.5±4.8、(8.2±2.1)d、(15.3±4.1)d,差异均有统计学意义(P<0.05);治疗前,两组患者的GCS评分比较差异无统计学意义(P>0.05),治疗后,两组患者的GCS评分明显升高,且研究组患者的GCS评分为(14.7±1.6)分,明显高于对照组的(13.1±1.4)分,差异均有统计学意义(P<0.05);研究组患者的不良反应总发生率为8.0%,明显低于对照组的28.0%,差异均有统计学意义(P<0.05)。结论纳洛酮联合BiPAP治疗COPD合并肺性脑病可有效提高患者的治疗效果,降低不良反应发生率。

Objective To study the rescue effect of naloxone combined with noninvasive positive pressure ventilation(BiPAP)on patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary encephalopathy.Methods The 50 patients with COPD complicated with pulmonary encephalopathy were selected as the research objects,who were treated in Gaozhou People's Hospital from August 1,2018 to August 1,2020.According to the random number table method,they were divided into a study group and a control group,with 25 cases each.Both groups of patients received conventional treatment.Then the control group was treated with BiPAP on the conventional treatment,and the study group was treated with naloxone on the basis of the control group.The partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),pH value,and Glasgow Coma Scale(GCS)score of the two groups were compared before and after treatment.The improvement time of consciousness disorder,the disappearance time of consciousness disorder,the time of noninvasive ventilation,the length of hospitalization and other related indicators after treatment were detected in the two groups,and the clinical efficacy and the total incidence of adverse reactions were compared between the two groups.Results The total effective rate of the study group was 96.0%,which was significantly higher than 80.0%of the control group,and the difference was statistically significant(P<0.05).Before treatment,there was no statistically significant difference in PaCO_(2),PaO_(2),and pH values between the two groups(P>0.05);after treatment,the PaCO_(2) values of the two groups were significantly decreased,and the PaO_(2) and pH values were significantly increased.The PaCO_(2) value in the study group was(42.7±1.6)mmHg,which was significantly lower than(49.3±1.9)mmHg in the control group;the values of PaO_(2) and pH were(73.7±3.4)mmHg and 8.1±0.6 in the study group,respectively,which were significantly higher than corresponding(64.2±3.1)mmHg and 7.7±0.5 in the control group(P<0.05).After treatment,the improvement time of consciousness disorder[(6.2±2.1)h vs(9.4±3.5)h],the disappearance time of consciousness disorder[(13.6±4.1)d vs(22.5±4.8)d],the time of noninvasive ventilation[(6.1±1.4)d vs(8.2±2.1)d],and the length of hospitalization[(11.5±3.2)d vs(15.3±4.1)d]were significantly shorter in the study group than in the control group,and all differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in GCS scores between the two groups(P>0.05);after treatment,the GCS scores of the two groups were significantly increased,and the GCS score of the study group was(14.7±1.6)points,which was significantly higher than(13.1±1.4)points of the control group,and the differences was statistically significant(P<0.05).The total incidence of adverse reactions in the study group was 8.0%,which was significantly lower than 28.0%in the control group(P<0.05).Conclusion Naloxone combined with BiPAP in the treatment of COPD with pulmonary encephalopathy can effectively improve the treatment effect and reduce the incidence of adverse reactions.