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目的探讨无创成比例机械通气联合纳洛酮治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的临床应用价值。方法105例慢性阻塞性肺疾病合并呼吸衰竭患者随机分为3组,在常规抗炎、解痉平喘、祛痰等治疗的基础上,对照组常规给予常规呼吸兴奋剂,PAV组应用无创成比例机械通气(PAV),PAV加纳洛酮组应用PAV通气联合盐酸纳洛酮治疗。在通气前、通气后24、48 h评价患者症状、生命体征及血气变化。结果对照组显效16例,有效4例,无效15例,总有效率57.1%;PAV组显效20例,有效5例,无效10例,总有效率71.4%;PAV联合纳洛酮组显效25例,有效6例,无效4例,总有效率88.6%;三组疗效差异有统计学意义(P<0.05)。对照组与PAV组及PAV加纳洛酮组治疗1、3 d后血气分析指标比较,差异有统计学意义(P<0.05)。PAV组与PAV加纳洛酮组治疗1、3 d后血气分析指标比较,差异有统计学意义(P<0.05)。结论成比例机械通气联合纳洛酮是治疗COPD呼吸衰竭合并肺性脑病患者的有效方法。
Objective To investigate the clinical value of noninvasive proportional ventilation combined with naloxone in the treatment of chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Methods A total of 105 patients with chronic obstructive pulmonary disease and respiratory failure were randomly divided into three groups. On the basis of conventional anti-inflammatory, antispasmodic and antiasthmatic effects and expectorant treatment, the control group was given conventional respiratory stimulant. PAV group was treated with non-invasive proportional mechanical Ventilation (PAV), PAV ganaxone group with PAV ventilation combined with naloxone hydrochloride treatment. Before ventilation, 24,48 h after ventilation evaluation of patient symptoms, vital signs and blood gas changes. Results In the control group, 16 cases were markedly effective, 4 cases were effective, 15 cases were ineffective and the total effective rate was 57.1%. In PAV group, 20 cases were markedly effective, 5 cases were effective, 10 cases were ineffective and the total effective rate was 71.4%. PAV combined with naloxone effectively markedly , 6 cases were effective, 4 cases were ineffective, and the total effective rate was 88.6%. The differences between the three groups were statistically significant (P <0.05). The blood gas analysis indexes of the control group, the PAV group and the ganaxone group of PAV for 1 and 3 days after treatment were significantly different (P <0.05). Blood gas analysis indexes of PAV group and PAV ganaxone group were higher than those of control group (P <0.05). Conclusion Proportional mechanical ventilation combined with naloxone is an effective treatment for COPD patients with respiratory failure and pulmonary encephalopathy.