CAJ | 학술논문

目的：观察无创正压通气（ NPPV）联合纳洛酮治疗慢性阻塞性肺疾病急性发作（ AECOPD ）合并肺性脑病的疗效。方法将AECOPD合并肺性脑病的患者78例随机分成2组，观察组39例，在综合治疗的基础上，采用NPPV联合纳洛酮治疗；对照组39例，除不用纳洛酮外，其他治疗同观察组。观察2组抢救成功率和失败率，并比较治疗前及治疗后3 d呼吸频率（ RR）、心率（ HR）、指脉氧饱和度（ SpO2）、呼气末二氧化碳分压（ PET CO2）及动脉血气指标的变化。结果（1）观察组总抢救成功率（92?．3％）虽较对照组（84．6％）高，但2组比较差异无统计学意义（ P ＞0．05）；（2）与治疗前比较，2组治疗3 d后RR、HR均改善（ P ＜0．01），2组治疗后比较差异无统计学意义（ P ＞0．05）。呼吸困难程度评分治疗前与治疗后比较：观察组[（1．70±0．61）分 vs．（2．78±0．64）分]、对照组[（1．72±0．58）分vs．（2．44±0．33）分]均改善明显（ P ＜0．05），2组治疗后比较差异有统计学意义（ P ＜0．05）。（3）与治疗前比较，治疗3 d后观察组pH、SaO2、PaO2、PaCO2、SpO2、PET CO2均改善，对照组除SpO2外，其余指标亦改善（ P ＜0．05或P ＜0．01）。2组pH、PaCO2、PETCO2比较差异有统计学意义（ P ＜0．01）。结论 NPPV治疗AECOPD合并肺性脑病具有较好的疗效，及早联用呼吸兴奋剂纳洛酮，可提高治疗效果，提高抢救成功率，降低气管插管率和病死率。
목적：관찰무창정압통기（ NPPV）연합납락동치료만성조새성폐질병급성발작（ AECOPD ）합병폐성뇌병적료효。방법장AECOPD합병폐성뇌병적환자78례수궤분성2조，관찰조39례，재종합치료적기출상，채용NPPV연합납락동치료；대조조39례，제불용납락동외，기타치료동관찰조。관찰2조창구성공솔화실패솔，병비교치료전급치료후3 d호흡빈솔（ RR）、심솔（ HR）、지맥양포화도（ SpO2）、호기말이양화탄분압（ PET CO2）급동맥혈기지표적변화。결과（1）관찰조총창구성공솔（92?．3％）수교대조조（84．6％）고，단2조비교차이무통계학의의（ P ＞0．05）；（2）여치료전비교，2조치료3 d후RR、HR균개선（ P ＜0．01），2조치료후비교차이무통계학의의（ P ＞0．05）。호흡곤난정도평분치료전여치료후비교：관찰조[（1．70±0．61）분 vs．（2．78±0．64）분]、대조조[（1．72±0．58）분vs．（2．44±0．33）분]균개선명현（ P ＜0．05），2조치료후비교차이유통계학의의（ P ＜0．05）。（3）여치료전비교，치료3 d후관찰조pH、SaO2、PaO2、PaCO2、SpO2、PET CO2균개선，대조조제SpO2외，기여지표역개선（ P ＜0．05혹P ＜0．01）。2조pH、PaCO2、PETCO2비교차이유통계학의의（ P ＜0．01）。결론 NPPV치료AECOPD합병폐성뇌병구유교호적료효，급조련용호흡흥강제납락동，가제고치료효과，제고창구성공솔，강저기관삽관솔화병사솔。
Objective To observe the therapeutic effect of noninvasive positive pressure ventilation ( NPPV) com-bined with naloxone in treatment of acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) complicated with pulmonary encephalopathy .Methods Seventy-eight cases of AECOPD patients with pulmonary encephalopathy were randomly divided into 2 groups, 39 cases in observation group , on the basis of comprehensive therapy , using NPPV combined with nal-oxone in treatment;39 cases in the control group , without naloxone , other treatment was same as the observation group .The 2 groups were observed the success rate and failure rate , and 3 d respiratory frequency ( RR) , heart rate ( HR) , pulse oxygen saturation (SpO2), end tidal carbon dioxide partial pressure (PETCO2) and changes of arterial blood gas indexes were com-pared before and after treatment .Results (1) Observation group's total success rate (92.3%) is higher than the control group (84.6%), but no significant differences between the 2 groups were found ( P >0.05); (2) Compared with before treatment, after 3 day treatment, RR and HR were improved in both of the 2 groups ( P <0.01), no significant difference were found between the 2 groups ( P >0.05).Comparison of respiratory score of before treatment and after treatment , both of the observation group [(1.70 ±0.61) vs.(2.78 ±0.64)] and the control group [(1.72 ±0.58) vs.(2.44 ± 0.33)] were improved significantly ( P <0.05), after treatment, there were significant difference between the 2 groups (P <0.05).(3) Compared with before treatment, after 3 days treatment, observation group's pH, SaO2, PaO2, PaCO2, SpO2, PETCO2 group were improved; in the control group, except SpO2,other indicators also improved (P <0.05, P <0.01).pH、PaCO2、PETCO2 were significant differences between the 2 groups( P <0.01).Conclusion The NPPV in treat-ment of AECOPD with pulmonary encephalopathy has good effect;early naloxone combined with respiratory stimulant can sig-nificantly improve the therapeutic effect ,improve the success rate ,and reduce the rate of endotracheal intubation and mortality .