纳洛酮结合经鼻高流量氧疗治疗慢性阻塞性肺疾病急性发作并Ⅱ型呼吸衰竭患者的效果

Effect of Naloxone combined with nasal high-flow oxygen therapy in thetreatment of patients with acute onset of chronic obstructive pulmo-nary disease and typeⅡrespiratory failure

目的探讨纳洛酮结合经鼻高流量氧疗治疗慢性阻塞性肺疾病急性发作并Ⅱ型呼吸衰竭患者的效果。方法选取2018年5月—2020年5月于山东省莱西市人民医院呼吸科确诊的92例慢性阻塞性肺疾病急性发作并Ⅱ型呼吸衰竭患者,按随机数字表法分为对照组和观察组,各46例。两组均予以常规治疗,对照组患者给予经鼻高流量氧疗,观察组患者在对照组的基础上给予纳洛酮进行治疗,疗程均为1周。比较两组患者治疗后临床疗效和治疗前后肺功能指标、血气分析指标、圣乔治呼吸问卷(SGRQ)评分和呼吸困难程度(MMRC)评分、血清Clara细胞分泌蛋白(CCL6)、肺部和活化控制趋因子(PARC/CCL18)和肺表面活性物质相关蛋白D(SP-D)水平。结果治疗后,观察组临床治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、第一秒用力呼气量占用力肺活量比值(FEV1/FVC)均高于治疗前,且观察组显著高于对照组,差异有统计学意义(P<0.05)。治疗后,两组动脉血氧分压(PaCO2)和血氧饱和度(SaO2)水平均高于治疗前,且观察组高于对照组(P<0.05),而两组动脉血二氧化碳分压(PaCO2)水平低于治疗前,且观察组低于对照组(P<0.05)。治疗后,两组SGRQ评分和MMRC评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组血清CCL6水平高于治疗前,且观察组高于对照组(P<0.05),而两组血清PARC/CCL18、SP-D水平均低于治疗前,且观察组低于对照组(P<0.05)。结论纳洛酮结合经鼻高流量氧疗治疗慢性阻塞性肺疾病急性发作并Ⅱ型呼吸衰竭患者临床效果确切,有效改善患者肺功能和呼吸功能,改善患者血气分析指标、血清CCL6、PARC/CCL18和SP-D水平。

Objective To explore the effect of Naloxone combined with nasal high-flow oxygen therapy in the treatment of patients with acute onset of chronic obstructive pulmonary disease and typeⅡrespiratory failure.Methods A total of 92 patients with acute onset of chronic obstructive pulmonary disease and typeⅡrespiratory failure diagnosed in the Respiratory Department of Laixi People's Hospital in Shandong Province from May 2018 to May 2020 were selected and divided into control group and observation group according to the random number table method,each group with 46 cas⁃es.Both groups were given conventional treatment.Patients in control group were given nasal high-flow oxygen therapy,and patients in observation group were given Naloxone on the basis of control group.The course of treatment was one week.The clinical efficacy after treatment,lung function indexes,blood gas indexes,SGRQ score and MMRC score,se⁃rum CCL6,PARC/CCL18 and SP-D levelsbefore and after treatment were compared between two groups.Results After treatment,the total effective rate of clinical treatment in observation group was significantly higher than that in control group(P<0.05).After treatment,FEV1,FVC and FEV1/FVC in two groups were higher than those before treatment,and those in observation group were significantly higher than those in control group,the differences were statistically signifi⁃cant(P<0.05).After treatment,the levels of PaO2 and SaO2 in two groups were higher than those before treatment,and those in observation group were higher than those in control group(P<0.05),while the level of PaCO2 in two groups was lower than that before treatment,and that in observation group was lower than that in control group(P<0.05).After treat⁃ment,SGRQ score and MMRC score of two groups were lower than those before treatment,and those in observation group were lower than those in control group,the differences were statistically significant(P<0.05).After treatment,the level of serum CCL6 in two groups was higher than that before treatment,and that in observation group was higher than that incontrol group(P<0.05),while the levels of serum PARC/CCL18 and SP-D in two groups were lower than those be⁃fore treatment,and those in observation group were lower than those in control group(P<0.05).Conclusion Naloxone combined with nasal high-flow oxygen therapy has a definite clinical effect in the treatment of patients with acute onset of chronic obstructive pulmonary disease and type II respiratory failure.It effectively improves the patient's lung and re⁃spiratory function,improves the patient's blood gas analysis indicators and serum CCL6,PARC/CCL18 and SP-D levels.