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目的探讨纳洛酮联合无创正压通气法治疗中老年慢性阻塞性肺疾病(COPD)伴呼吸衰竭的临床疗效。方法选取2013年8月—2014年9月贵港市覃塘区人民医院收治的中老年COPD伴呼吸衰竭患者72例,根据治疗方法不同分为观察组与对照组,各36例。两组患者均给予常规药物治疗,在此基础上对照组患者予以无创正压通气法治疗,观察组予以纳洛酮联合无创正压通气法治疗。比较两组患者临床疗效,观察两组患者治疗前后血p H值、血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、第1秒用力呼气末容积占用力肺活量百分比(FEV1/FVC)、残气量/肺总量比值(RV/TLC),观察两组患者上机时间、住院时间及不良反应发生情况。结果观察组患者总有效率高于对照组,差异有统计学意义(P<0.05);治疗前两组患者血p H值、Pa O2、Pa CO2比较,差异无统计学意义(P>0.05);治疗后观察组患者血p H值、Pa O2高于对照组,Pa CO2低于对照组,差异有统计学意义(P<0.05);治疗前两组患者FEV1/FVC、RV/TLC比较,差异无统计学意义(P>0.05);治疗后两组患者FEV1/FVC比较,差异无统计学意义(P>0.05);治疗后观察组RV/TLC低于对照组,差异有统计学意义(P<0.05);观察组患者上机时间、住院时间短于对照组,差异有统计学意义(P<0.05);两组患者均未发生明显不良反应。结论纳洛酮联合无创正压通气法治疗中老年COPD伴呼吸衰竭的临床疗效显著,能有效改善患者血气分析指标、肺功能指标、临床症状,缩短患者上机时间、住院时间,且不良反应少。
Objective To investigate the clinical efficacy of naloxone in combination with noninvasive positive pressure ventilation in treating middle-aged and elderly patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods Seventy-two elderly COPD patients with respiratory failure were enrolled in this study from August 2013 to September 2014 in Guitang District People’s Hospital of Guigang. According to the different treatment methods, they were divided into observation group and control group, with 36 cases in each group. Two groups of patients were given conventional drug treatment, on the basis of which patients in the control group were treated with non-invasive positive pressure ventilation, the observation group was treated with naloxone combined with noninvasive positive pressure ventilation. The clinical effects of two groups of patients were compared. The changes of blood p H, Pa O 2, Pa C 2, and forced expiratory volume in one second before and after treatment were observed. FEV1 / FVC) and residual volume / total lung volume ratio (RV / TLC). The time of going on machine, length of hospital stay and adverse reactions in both groups were observed. Results The total effective rate in the observation group was higher than that in the control group (P <0.05). There was no significant difference in blood p H, Pa O2 and Pa CO2 between the two groups before treatment (P> 0.05) ; After treatment, the blood p H value in the observation group patients was higher than that in the control group, and PaCO 2 was lower than that in the control group (P <0.05); before treatment, FEV 1 / FVC and RV / (P> 0.05). There was no significant difference in FEV1 / FVC between the two groups after treatment (P> 0.05). After treatment, RV / TLC in the observation group was lower than that in the control group (P <0.05) P <0.05). The patients in observation group had shorter duration of hospitalization and hospital stay than those in control group (P <0.05). No significant adverse reactions occurred in both groups. Conclusion Naloxone and noninvasive positive pressure ventilation are effective in treating middle-aged and elderly patients with COPD and respiratory failure. It can effectively improve the blood gas analysis indexes, lung function indexes and clinical symptoms, and shorten the time of on-boarding and hospitalization, and less adverse reactions .