高流量氧疗联合纳洛酮治疗老年重症急性呼吸衰竭患者的疗效

Efficacy of high flow oxygen therapy combined with naloxone in elderly patients with severe acute respiratory failure

目的探讨高流量氧疗联合纳洛酮治疗老年重症急性呼吸衰竭(acute respiratory failure,ARF)患者的疗效。方法选取126例老年重症ARF患者作为研究对象,随机分为对照组和观察组,每组63例。对照组给予经鼻高流量氧疗,观察组在对照组治疗的基础上给予纳洛酮治疗,2组均治疗1周。评估2组的临床疗效,比较2组治疗前后的肺功能指标[第1秒用力呼气容积(forced expiratory volume in first second,FEV1)、用力肺活量(forced vital capacity,FVC)和FEV1/FVC值]、血气分析指标[动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))和血氧饱和度(oxygen saturation,SaO_(2))]、血清生化标志物[C-C趋化因子配体6(C-C motif chemokine ligand 6,CCL6)、肺部活化调节趋化因子/趋化因子配体18(pulmonary activation regulated chemokine/C-C motif chemokine ligand 18,PARC/CCL18)和肺表面活性物质相关蛋白-D(surfactant protein-D,SP-D)]水平的变化,观察并记录2组的预后情况[再插管率、48 h肺部感染率、重症监护室(intensive care unit,ICU)住院时间及28 d病死率]。结果治疗后,观察组的临床总有效率(93.65%)明显高于对照组(77.77%),P<0.05;2组的FEV1、FVC、FEV1/FVC值,PaO_(2)、SaO_(2)较治疗前均显著提高(P<0.05),PaCO_(2)较治疗前显著降低(P<0.05);2组的血清CCL6水平较治疗前显著提高(P<0.05),血清PARC/CCL18及SP-D水平较治疗前显著降低(P<0.05);观察组的以上指标变化幅度均显著高于对照组(P<0.05)。观察组的再插管率为17.46%,显著低于对照组的33.33%,48 h肺部感染率为9.52%,显著低于对照组的23.81%,ICU住院时间显著短于对照组(P<0.05)。2组的28 d病死率比较差异无统计学意义(P>0.05)。结论高流量氧疗联合纳洛酮治疗老年重症ARF患者疗效显著,能明显改善肺功能和血气分析指标,对血清CCL6水平起到上调作用,并能抑制血清PARC/CCL18及SP-D的高水平表达,其能改善机体炎症情况,降低患者的再插管率和48 h肺部感染率,缩短ICU住院时间,改善患者预后情况。

Objective To explore the efficacy of high flow oxygen therapy combined with naloxone in the treatment of elderly patients with severe acute respiratory failure(ARF).Methods 126 elderly patients with severe ARF were selected and randomly divided into a control group and an observation group,with 63 cases in each group.The control group was given nasal high flow oxygen therapy,and the observation group was given naloxone therapy based on the above treatment.The both groups were treated for 1 week.The clinical efficacy was evaluated in the 2 groups,and the pulmonary function indicators[forced expiratory volume in first second(FEV1),forced vital capacity(FVC),and FEV1/FVC],blood gas indicators[partial pressure of arterial oxygen(PaO_(2)),partial pressure of arterial carbon dioxide(PaCO_(2))and blood oxygen saturation(SaO_(2))]and serum biochemical markers[C-C motif chemokine ligand 6(CCL6),pulmonary activation regulated chemokine/C-C motif chemokine ligand 18(PARC/CCL18)and surfactant protein-D(SPD)]were compared between the 2 groups before and after treatment.The prognosis[re-intubation rate,48 hours pulmonary infection rate,intensive care unit(ICU)stay and 28 days mortality]were observed and recorded in the 2 groups.Results The total clinical effective rate in the observation group after treatment was significantly higher than that in the control group(93.65%vs.77.78%,P<0.05).The FEV1,FVC,FEV1/FVC,PaO_(2)and SaO_(2)in both groups were significantly increased compared with those before treatment(P<0.05),while the PaCO_(2)was significantly decreased(P<0.05),and the level of serum CCL6 was significantly increaled(P<0.05)while the levels of serum PARC/CCL18 and SP-D were significantly reduced compared with those before treatment(P<0.05),and the changes of the above indicators in the observation group were significantly greater than those in the control group(P<0.05).The re-intubation rate and 48 hours pulmonary infection rate in the observation group were significantly lower than those in the control group(17.46%vs.33.33%,9.52%vs.23.81%,P<0.05),and the duration of ICU stay was significantly shorter than that in the control group(P<0.05).There was no significant difference in 28 days mortality between the 2 groups(P>0.05).Conclusion High flow oxygen therapy combined with naloxone has significant efficacy in the treatment of elderly patients with severe ARF.The combination can significantly improve the pulmonary function and blood gas analysis indicators,playing an up-regulation role in serum CCL6 level and inhibiting the high expressions of serum PARC/CCL18 and SP-D.The combination also can ameliorate the inflammation of the body,reduce the re-intubation rate and 48 hours pulmonary infection rate,shorten the ICU stay and improve the prognosis.