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目的:探讨纳洛酮治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭患者血清降钙素原、炎症因子的改变及临床疗效。方法:收集2013年5月至2014年9月来我院治疗的COPD合并Ⅱ型呼吸衰竭患者60例,根据治疗方法不同随机分为对照组和观察组,对照组给与常规治疗,观察组在常规治疗的基础上给与纳洛酮治疗。记录两组患者在治疗前后静脉血Pa CO2、Pa O2的变化以及临床疗效。采用Elisa法检测两组患者在治疗前后血清PCT、TNF-α、IL-6含量的变化,并用RT-PCR法检测两组患者在治疗前后血清PCT、TNF-α、IL-6 DNA的改变。结果:观察组患者在治疗前静脉血Pa CO2的值为81.3±9.4 mm Hg,治疗后下降为45.4±5.3mm Hg,Pa O2由49.6±3.9 mm Hg上升至81.3±5.9 mm Hg,均优于对照组,与对照组比较差异有统计学意义(P<0.05);临床总有效率为85.7%,高于对照组的68%,且差异有统计学意义(P<0.05)。ELISA检测结果显示,两组患者在治疗后,血清PCT,CRP、IL-6含量均显著下降,且观察组下降程度高于对照组,RT-PCR检测结果与ELISA检测结果相一致。结论:纳洛酮治疗COPD合并Ⅱ型呼吸衰竭的临床疗效显著,能有效的提高Pa O2,降低Pa CO2,且能有效的减缓炎症反应的加重。
Objective: To investigate the changes of serum procalcitonin and inflammatory cytokines in patients with chronic obstructive pulmonary disease and type Ⅱ respiratory failure treated with naloxone and its clinical efficacy. Methods: Sixty patients with COPD and type Ⅱ respiratory failure who were treated in our hospital from May 2013 to September 2014 were randomly divided into control group and observation group according to different treatment methods. The control group was given routine treatment. Routine treatment is given on the basis of naloxone treatment. The changes of PaCO 2 and PaO 2 in the venous blood before and after the treatment were recorded and the clinical efficacy was recorded. The changes of serum PCT, TNF-α and IL-6 levels in both groups before and after treatment were detected by Elisa method. The changes of serum PCT, TNF-α and IL-6 DNA in both groups before and after treatment were detected by RT-PCR. Results: Before treatment, PaCO 2 value in the venous blood of the observation group was 81.3 ± 9.4 mm Hg, decreased to 45.4 ± 5.3 mm Hg after treatment and Pa O 2 increased from 49.6 ± 3.9 mm Hg to 81.3 ± 5.9 mm Hg The difference between the control group and the control group was statistically significant (P <0.05). The total clinical effective rate was 85.7%, which was higher than that of the control group (68%), and the difference was statistically significant (P <0.05). The results of ELISA showed that the levels of PCT, CRP and IL-6 in serum were significantly decreased in both groups after treatment, and the decrease in observation group was higher than that in control group. The results of RT-PCR were consistent with those of ELISA. Conclusion: Naloxone is effective in treating COPD with type Ⅱ respiratory failure. It can effectively increase Pa O2 and decrease Pa CO2, and can effectively reduce the aggravation of inflammatory reaction.