无创正压通气联合盐酸纳洛酮注射液治疗慢性阻塞性肺疾病急性加重期并呼吸衰竭的临床疗效及其对患者肺功能和生活质量的影响

摘要

目的：探讨无创正压通气联合盐酸纳洛酮注射液治疗慢性阻塞性肺疾病急性加重期（AECOPD）并呼吸衰竭的临床疗效及其对患者肺功能和生活质量的影响。方法选取2014年1月—2015年6月上海市徐汇区大华医院呼吸内科收治的 AECOPD 并呼吸衰竭患者106例，按随机数字表法分为对照组56例与观察组50例。对照组患者予以无创正压通气治疗，观察组患者在对照组基础上加用盐酸纳洛酮注射液治疗；两组患者均治疗1周。比较两组患者临床疗效、治疗前后肺功能指标〔氧分压（PaO2）、二氧化碳分压（PaCO2）、氧合指数（PaO2/ FiO2）〕和生活质量评分、不良反应/并发症发生情况。结果观察组患者临床疗效优于对照组（P <0.05）。治疗前两组患者 PaO2、PaCO2、PaO2/ FiO2比较，差异无统计学意义（P >0.05）；治疗后观察组患者 PaO2、PaO2/ FiO2高于对照组，PaCO2低于对照组（P <0.05）。治疗前两组患者躯体评分、认知评分、情绪评分、角色评分、社会功能评分和总体健康评分比较，差异无统计学意义（P >0.05）；治疗后观察组患者躯体评分、认知评分、情绪评分、角色评分、社会功能评分和总体健康评分高于对照组（P <0.05）。两组患者均未发生严重不良反应/并发症。结论无创正压通气联合盐酸纳洛酮注射液治疗 AECOPD 并呼吸衰竭的临床疗效确切，可有效改善患者肺功能，提高患者的生活质量。%Objective To explore the clinical effect of non - invasive positive pressure ventilation combined with naloxone hydrochloride injection in treating AECOPD patients complicated with respiratory failure and the impact on pulmonary function and quality of life. Methods From January 2014 to June 2015,a total of 106 AECOPD patients complicated with respiratory failure were selected in the Department of Respiratory Medicine,Dahua Hospital of Xuhui District,Shanghai,and they were divided into control group( n = 56) and observation group( n = 50) according to random number table. Patients of control group received non - invasive positive pressure ventilation,while patients of observation group received non - invasive positive pressure ventilation combined with naloxone hydrochloride injection;both groups continuously treated for 1 week. Clinical effect,index of pulmonary function(including PaO2 ,PaCO2 and PaO2 / FiO2 )and life quality score before and after treatment, and incidence of adverse/ complications were compared between the two groups. Results Clinical effect of observation group was statistically significantly better than that of control group(P < 0. 05). No statistically significant differences of PaO2 ,PaCO2 or PaO2 / FiO2 was found between the two groups before treatment(P > 0. 05);after treatment,PaO2 and PaO2 / FiO2 of observation group were statistically significantly higher than those of control group,while PaCO2 of control group was statistically significantly lower than that of control group(P < 0. 05). No statistically significant differences of physical score,cognitive score,emotional score,role score,social function score or overall health score was found between the two groups before treatment(P > 0. 05), while physical score,cognitive score,emotional score,role score,social function score and overall health score of observation group were statistically significantly higher than those of control group after treatment( P < 0. 05). No one of the two groups occurred any severe adverse reactions or complications. Conclusion Non - invasive positive pressure ventilation combined with naloxone hydrochloride injection has certain clinical effect in treating AECOPD patients complicated with respiratory failure,can effectively improve the pulmonary function and quality of life.