纳洛酮辅助HFNC在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭中的应用效果  

Application Effect of Naloxone-assisted HFNC in Patients with AECOPD Complicated with Type Ⅱ Respiratory Failure

作　　者：郝涛利 王翠琴 王晓颖 贺文德 季建蕊 李江涛 HAO Taoli;WANG Cuiqin;WANG Xiaoying;HE Wende;JI Jianrui;LI Jiangtao(Department of Geriatrics,General Hospital of Handan Mining Group,North China Medical and Health Group,Shijiazhuang 056000,China;Department of Respiratory Medicine,Military Medical University Hospital,Shijiazhuang 050000,China;Department of Respiratory and Critical Care Medicine,Hebei Chest Hospital,Shijiazhuang 050000,China)

机构地区：[1]华北医疗健康集团邯矿总医院老年病科,石家庄056000 [2]陆军军医大学士官学校附属医院呼吸内科,石家庄050000 [3]河北省胸科医院呼吸与危重症医学三科,石家庄050000

出　　处：《临床误诊误治》2023年第10期80-85,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划项目(20200828)。

摘　　要：目的探究纳洛酮辅助经鼻高流量湿化氧疗(HFNC)在慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者中的应用效果。方法选取2020年1月—2023年1月收治的AECOPD合并Ⅱ型呼吸衰竭120例,按治疗方法分为对照组和研究组,每组60例。对照组给予HFNC,研究组给予纳洛酮辅助HFNC。比较2组临床疗效,治疗前后肺功能指标[第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、肺总量(TLC)]、临床症状[急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷量表(GCS)评分]、动脉血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]、炎症-应激指标[C反应蛋白(CRP)、降钙素原(PCT)、超氧化物歧化酶(SOD)、丙二醛(MDA)]、血清颗粒蛋白前体(PGRN)、血管生成素-2(Ang-2)水平;记录2组不良反应发生情况。结果研究组治疗总有效率91.67%(55/60)高于对照组76.67%(46/60)(P<0.05)。研究组治疗3、7 d后FEV1、FEV1/FVC、TLC、GCS评分、PaO_(2)、SaO_(2)、SOD高于对照组,APACHEⅡ评分、PaCO_(2)及血清CRP、PCT、MDA、PGRN、Ang-2水平低于对照组(P<0.05)。2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论采用纳洛酮辅助HFNC治疗AECOPD合并Ⅱ型呼吸衰竭能更有效改善患者肺功能及氧合状态,减轻炎症反应、氧化应激程度,下调血清PGRN、Ang-2水平,从而增强疗效,且具有一定安全性。Objective To investigate the application effect of Naloxone-assisted high-flow nasal cannula oxygen therapy(HFNC)in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with type Ⅱ respiratory failure(Ⅱ-RF).Methods In total,120 patients with AECOPD complicated with Ⅱ-RF in our hospital from January 2020 to January 2023 were selected and randomly divided into control group(n=60)and research group(n=60).The control group was given HFNC,and the research group was given Naloxone-assisted HFNC.The therapeutic effect,pulmonary function indexes[forced expiratory volume in the first second(FEV1),FEV1/forced vital capacity(FVC),total lung volume(TLC)],clinical symptoms[acute physiological function and chronic health evaluation scoring System Ⅱ(APACHEⅡ)score,Glasgow Coma Scale(GCS)score],arterial blood gas analysis indexes[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),arterial oxygen saturation(SaO_(2))],inflammatory stress indexes[C reactive protein(CRP),procalcitonin(PCT),superoxide dismutase(SOD),malondialdehyde(MDA)],progranulin(PGRN),and angiopoietin-2(Ang-2)level before and after treatment were compared between the two groups.The incidence of adverse reactions of the two groups was recorded.Results The total effective rate of the research group was 91.67%(55/60),which was higher than that of the control group[76.67%(46/60)](P<0.05).At 3 and 7 days after treatment,FEV1,FEV1/FVC,TLC,GCS scores,PaO_(2),SaO_(2) and SOD levels in the research group were higher than those in the control group,while APACHEⅡ scores,PaCO_(2) and serum CRP,PCT,MDA,PGRN and Ang-2 levels in the research group were lower than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Naloxone-assisted HFNC in the treatment of AECOPD patients with Ⅱ-RF can more effectively improve lung function and oxygenation status,reduce inflammation and oxidative stress,an

关 键 词：肺疾病 慢性阻塞性 Ⅱ型呼吸衰竭 纳洛酮 经鼻高流量湿化氧疗 第1秒用力呼气容积 急性生理功能和慢性健康状况评分系统Ⅱ 血清颗粒蛋白前体 血管生成素-2 

分 类 号：R563.9[医药卫生—呼吸系统]