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(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)]、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、7d后FEV1、FEV1/FVC、TLC、GCS评分、PaO2、SaO2、SOD高于对照组,APACHEⅡ评分、PaCO2 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.
Abstract
Objective To investigate the application effect of Naloxone-assisted high-flow nasal cannula oxygen thera-py(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 withⅡ-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 func-tion 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(PaO2),arterial partial pressure of carbon dioxide(PaCO2),arterial oxygen saturation(SaO2)],inflammatory stress indexes[C reac-tive 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 was91.67%(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,PaO2,SaO2 and SOD levels in the research group were higher than those in the con-trol group,while APACHEⅡ scores,PaCO2 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 re-actions between the two groups(P＞0.05).Conclusion Naloxone-assisted HFNC in the treatment of AECOPD patients withⅡ-RF can more effectively improve lung function and oxygenation status,reduce inflammation and oxidative stress,and lower serum PGRN and Ang-2 levels,so as to enhance efficacy and have certain safety.
基金项目
河北省医学科学研究重点课题计划项目(20200828)
维普
万方数据