无创通气模式下采用纳洛酮联合中药汤剂方对老年COPD合并Ⅱ型呼吸衰竭患者血气指标、肺功能及心理状态的影响

Effects of naloxone combined with traditional Chinese medicine decoction in non-invasive ventilation mode on blood gas indexes,pulmonary function and psychological state in elderly patients with COPD and typeⅡrespiratory failure

目的探讨无创通气模式下采用纳洛酮联合中药汤剂方对老年慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者血气指标、肺功能及心理状态的影响。方法选取2016年3月至2018年3月该院收治的152例老年COPD合并Ⅱ型呼吸衰竭患者作为研究对象,分为观察组和对照组,每组各76例。两组患者均采用无创机械通气进行治疗,对照组患者采用纳洛酮治疗,观察组患者在以上基础上给予中医辨证论治下的自拟汤剂治疗,比较两组患者血气指标、心率、呼吸频率、治疗满意度等情况;治疗前后采用肺功能仪检测患者肺功能指标,包括第1秒用力呼气容积(FEV1)/用力肺活量(FVC)、FEV1实际值与预计值比值(FEV1%pred)、最大自主通气量(MVV);治疗前后采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估患者焦虑和抑郁情况。结果观察组和对照组患者治疗前动脉血氧分压(PaO_(2))和动脉血二氧化碳分压(PaCO_(2))比较,差异均无统计学意义(P>0.05);观察组患者治疗后PaO_(2)和PaCO_(2)均优于对照组,差异均有统计学意义(P<0.05)。两组患者治疗前心率和呼吸频率比较,差异均无统计学意义(P>0.05);观察组患者治疗后心率和呼吸频率均低于对照组,差异均有统计学意义(P<0.05)。观察组患者治疗总有效率和治疗总满意度均明显高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。观察组患者治疗后FEV1/FVC、FEV1%pred和MVV均明显高于治疗前和对照组治疗后,差异均有统计学意义(P<0.05)。两组患者治疗后SAS和SDS评分均明显低于同组治疗前,且观察组患者治疗后SAS和SDS评分均低于对照组治疗后,差异均有统计学意义(P<0.05)。结论无创通气模式下采用纳洛酮联合自拟中药汤剂治疗对改善老年COPD合并Ⅱ型呼吸衰竭患者血气指标、心率、呼吸频率效果更佳,可以提升患者肺功能,疏导患者不良情绪,提高患者治疗满意度。

Objective To explore the effect of naloxone combined with traditional Chinese medicine decoction in non-invasive ventilation mode on blood gas indexes,pulmonary function and psychological state in elderly patients with chronic obstructive pulmonary disease(COPD)and typeⅡrespiratory failure.Methods A total of 152 elderly patients with COPD and typeⅡrespiratory failure were selected as the research objects and divided into an observation group and a control group,with 76 cases in each group.Both groups of patients were treated with non-invasive mechanical ventilation,the control group was treated with naloxone,and the observation group was treated with self-made decoction based on traditional Chinese medicine syndrome differentiation on the basis of the above.Compared the blood gas indexes,heart rate,respiratory rate and treatment satisfaction between the two groups of patients.Before and after treatment,pulmonary function indicators were detected by pulmonary functionmeter,including forced expiratory volume in 1 second(FEV1)/forced vital capacity(FVC),ratio of FEV1 actual value to predicted value(FEV1%pred),and maximum voluntary ventilation(MVV).Self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to assess anxiety and depression conditions before and after treatment.Results There was no significant difference in arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))between the observation group and the control group before treatment(P>0.05).After treatment,PaO_(2) and PaCO_(2) in the observation group were better than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in heart rate and respiratory rate between the two groups before treatment(P>0.05).After treatment,the heart rate and respiratory rate in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The total treatment efficiency and total treatment satisfaction in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).After treatment,the FEV1/FVC,FEV1%pred and MVV in the observation group were significantly higher than those before treatment and the control group after,and the differences were statistically significant(P<0.05).The SAS and SDS scores in the two groups after treatment were significantly lower than those before treatment,and the SAS and SDS scores in the observation group after treatment were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Naloxone combined with self-made traditional Chinese medicine decoction in non-invasive ventilation mode has better improvement effect on blood gas indexes,heart rate and respiratory rate in elderly COPD patients with typeⅡrespiratory failure.It could improve the pulmonary function of patients,relieve the negative emotions of patients,and improve the satisfaction of patients with treatment.