大剂量纳洛酮对COPD急性加重期Ⅱ型呼吸衰竭的影响

Effects of High Dose Naloxone on the TypeⅡ Respiratory Failure of Chronic Obstructive Pulmonary Disease in Acute Exacerbation Time

关键词:  慢性阻塞性肺疾病  纳洛酮  临床转归  有创性辅助机械通气

Key words:  chronic obstructive pulmonary disease  naloxone  clinical turnover  traumatic mechanical ventilation

摘要:

目的 探讨大剂量纳洛酮对慢性阻塞性肺疾病(COPD)急性加重期伴Ⅱ型呼吸衰竭患者的疗效。方法 回顾性调查2006年1月—2009年6月我院COPD急性加重期伴Ⅱ型呼吸衰竭、呼吸性酸中毒患者115例，按纳洛酮给药方式分为推注组、微泵组、滴注组和对照组。对照组55例给予常规治疗；推注组、微泵组、滴注组共60例在常规治疗的基础上给予纳洛酮1.2~2 mg，加入0.9%氯化钠注射液中静脉推注或微泵静脉注射、静脉滴注。观察患者出院时的临床转归、辅助机械通气、血气分析、心率、呼吸频率。结果 推注组、微泵组、滴注组、对照组好转率分别为77.78%，90.91%，81.82%，90.91%，各组差异无统计学意义(P>0.05)。推注组需有创性机械通气率为51.85%，显著高于微泵组的22.73%、滴注组的33.33%和对照组的27.27%(P<0.05)。治疗2 d后，各组pH都有升高，二氧化碳分压(PCO₂)均有下降，微泵组、滴注组、对照组氧气分压(PO₂)稍有上升，推注组PO₂稍有下降，比较治疗前后，除对照组pH有显著上升外(P<0.05)，其他各组各指标无显著变化(P>0.05)。心动过速、呼吸急促的此类患者使用大剂量纳洛酮后其呼吸频率和心率不能减慢甚至加快。结论 大剂量纳洛酮不能改善COPD急性加重期伴Ⅱ型呼吸衰竭患者的临床转归，静脉推注更增加其有创性机械通气的风险。

Abstract:

OBJECTIVE To investigate the effects of high dose naloxone on the type II respiratory failure of chronic obstructive pulmonary disease(COPD) in acute exacerbation time. METHODS From Jan 2006 to Jun 2009, 115 cases of COPD accompanied with type II respiratory failure and respiratory acidosis in acute exacerbation time were retrospectively analyzed and divided into iv group, iv-vp group, ivgtt group and control group. The 55 cases in control group were given routine treatment, while the other 3 groups (60 cases in all groups) were given naloxone 1.2-2 mg added in 0.9% sodium chloride injection by intravenous push injection, minipump intravenous injection, and intravenously guttae on routine treatment, respectively. Observe the clinical turnover, mechanical ventilation, blood gas analysis, heart rate and breathing rate in the four groups before the patients discharged. RESULTS There was no significant difference among the four groups with improvement rate(P>0.05), which was 77.78%, 90.91%, 81.82%, 90.91% in iv group, iv-vp group, ivgtt group and control group, respectively. Traumatic mechanical ventilation rate in iv group was 51.85%, which was significantly higher than in the iv-vp group which was 22.73%, ivgtt group 33.33%, and control group 27.27%(P<0.05). After two days of treatment, pH in each group was significantly increased, PCO₂ was decreased, PO₂ of iv group was slightly decreased while the other three groups were slightly increased. The index (pH, PCO₂, PO₂) of experimental groups had no obvious significance(P>0.05) except the pH of control group (P<0.05). The respiratory rate and heart rate did not slow down even accelerate in the patients of type II respiratory failure of COPD accompanied tachycardia and tachypnea after using high dose naloxone. CONCLUSION High dose naloxone couldn’t improve clinical turnover of type II respiratory failure of COPD in acute exacerbation time and high dose naloxone by intravenous push injection even increased the risk of traumatic mechanical ventilation.