甘露醇联合尼可刹米、纳洛酮治疗慢性阻塞性肺疾病呼吸衰竭并发轻型肺性脑病的临床观察

Clinical Observation about Mannitol and Nikethamide and Naloxone Treatment on Chronic Obstructive Pulmonary Disease (AECOPD) Complicated by Respiratory Failure with Light Pulmonary Encephalopathy

摘要: 目的：观察甘露醇联合尼可刹米、纳洛酮治疗慢性阻塞性肺疾病呼吸衰竭并发轻型肺性脑病的临床疗效。方法：将2015年1月到2016年6月我科慢性阻塞性肺疾病呼吸衰竭并发轻型肺性脑病患者36例随机分为治疗组18例，对照组18例。两组均予持续低流量吸氧,积极控制感染，解痉平喘，止咳化痰，保持气道通畅，维持酸碱水、电解质平衡,营养支持等综合治疗；治疗组另加用甘露醇、尼可刹米、纳洛酮三药联合治疗。尼可刹米0.375 g入小壶，每3小时一次。甘露醇125ml静点，每日两次。纳洛酮1mg入小壶，每6小时一次。对照组仅用尼可刹米，观察两组治疗后24 h、72 h临床症状、格拉斯哥评分、血气及血清NSE的变化。结果:治疗组24 h、72 h后在症状、格拉斯哥评分、血气分析的改善方面优于对照组(P < 0.05)，而NSE在治疗前后变化不大，治疗组和对照组间无差异(P > 0.05)。结论:甘露醇联合尼可刹米、纳洛酮治疗慢性阻塞性肺疾病呼吸衰竭并发轻型肺性脑病明显优于对照组，且安全、有效，值得推广。

Abstract: Objective: To observe the clinical efficacy of mannitoland nikethamide and naloxone treatment on AECOPD complicated by respiratory Failure with light pulmonary encephalopathy. Methods: Thirty-six patients of AECOPD complicated by respiratory failure with light pulmonary encepha-lopathy in our department from Jan. 2015 to Jun. 2016 were randomly divided into eighteen treatment group and eighteen control group. All patients were continued low discharge Oxygen inhalation, actived to control infections, spasmolysis and relieving asthma, relieving cough and reducing sputum, kept airway expedite, maintained acid-base water electrolyte balance, nutri-tious support in comprehensive treatment. In treatment group, mannitol and nikethamide and naloxone were given. Nikethamide 0.375 g joined pipkin, each 3 h once, mannitol 125 ml stag-natde point, bid, naloxone 1 mg joined pipkin, each 6 h once. In control group, only nikethamide was used. Clinical symptoms, Glasgow Coma Scale (GCS) and artery blood gas test and plasma neuron-specific enolase (NSE) were observed at 24 h, 72 h in both two groups. Results: Clinical symptoms, Glasgow Coma Scale (GCS) and Blood-gas analysis indices (pH value, PaCO2 and PaO2) were significantly improved in treatment group. Compared with control group in same time-points (24 h and 72 h), the differences were statistically significant (all P < 0. 05). But NSE changed hardly in pretherapy and post-treatment, the difference was not statistically significant (P > 0. 05) in NSE of two groups. Conclusion: The efficiency and safety of mannitol and nikethamide and naloxone treatment on chronic obstructive pulmonary disease (AECOPD) complicated by respiratory Failure with light pulmonary encephalopathy are satisfactory. It is worth to popularize.

文章引用：曹晓红, 郑丽琴, 张新日. 甘露醇联合尼可刹米、纳洛酮治疗慢性阻塞性肺疾病呼吸衰竭并发轻型肺性脑病的临床观察[J]. 药物资讯, 2017, 6(2): 41-45. https://doi.org/10.12677/PI.2017.62008

参考文献

[1]	全国第三次肺心病专业会议. 肺性脑病的诊断和临床分级标准[J]. 中华结核和呼吸杂志, 1981(4): 62.
[2]	何莲, 雷宇. 肺脑合剂联合BiPAP无创呼吸机治疗肺性脑病的疗效观察[J]. 吉林医学, 2011, 32 (21): 4360-4361.
[3]	中华医学会重症医学分会. 慢性阻塞性肺疾病急性加重患者机械通气指南(2007)[J]. 中华急诊医学杂志, 2007, 16(4): 350-357.
[4]	季蓉, 何权瀛. 内源性阿片肽在呼吸调控中的作用[J]. 中华结核和呼吸杂志, 1999, 22(7): 440.
[5]	游古立. 纳洛酮辅治Ⅱ型呼吸衰竭肺性脑病的疗效观察[J]. 临床合理用药, 2009, 2(14): 15-16.
[6]	梁瑜. 纳洛酮联合呼吸兴奋合剂治疗慢性阻塞性肺疾病并肺性脑病临床观察[J]. 蛇志, 2013, 25(1): 31-32.
[7]	曾锤利. 纳洛酮联合无创通气在COPD并发轻、中度肺性脑病治疗中的应用[J]. 重庆医学, 2012, 41(14): 1412- 1413.
[8]	王劭晟, 朱明辉, 保学明. 纳洛酮与甘露醇联合抢救Ⅱ型呼吸衰竭并肺性脑病30例疗效观察[J]. 实用医学杂志, 2007, 23(11): 1725-1726.
[9]	项公强, 王国胜, 王强和. 慢性阻塞性肺疾病患者血清脑特异性蛋白、神经元特异性烯醇化酶水平的变化及临床意义[J]. 实用医学杂志, 2009, 25(19): 3231-3232.
[10]	鲍敏, 甄海宁, 雷贤华. 肺性脑病患者血清神经元特异性烯醇化酶和S 100β蛋白检测的意义[J]. 细胞与分子免疫学杂志, 2011, 27(8): 911-912.
[11]	全国第三次肺心病专业会议. 肺性脑病的诊断和临床分级标准[J]. 中华结核和呼吸杂志, 1981(4): 62.
[12]	何莲, 雷宇. 肺脑合剂联合BiPAP无创呼吸机治疗肺性脑病的疗效观察[J]. 吉林医学, 2011, 32 (21): 4360-4361.
[13]	中华医学会重症医学分会. 慢性阻塞性肺疾病急性加重患者机械通气指南(2007)[J]. 中华急诊医学杂志, 2007, 16(4): 350-357.
[14]	季蓉, 何权瀛. 内源性阿片肽在呼吸调控中的作用[J]. 中华结核和呼吸杂志, 1999, 22(7): 440.
[15]	游古立. 纳洛酮辅治Ⅱ型呼吸衰竭肺性脑病的疗效观察[J]. 临床合理用药, 2009, 2(14): 15-16.
[16]	梁瑜. 纳洛酮联合呼吸兴奋合剂治疗慢性阻塞性肺疾病并肺性脑病临床观察[J]. 蛇志, 2013, 25(1): 31-32.
[17]	曾锤利. 纳洛酮联合无创通气在COPD并发轻、中度肺性脑病治疗中的应用[J]. 重庆医学, 2012, 41(14): 1412- 1413.
[18]	王劭晟, 朱明辉, 保学明. 纳洛酮与甘露醇联合抢救Ⅱ型呼吸衰竭并肺性脑病30例疗效观察[J]. 实用医学杂志, 2007, 23(11): 1725-1726.
[19]	项公强, 王国胜, 王强和. 慢性阻塞性肺疾病患者血清脑特异性蛋白、神经元特异性烯醇化酶水平的变化及临床意义[J]. 实用医学杂志, 2009, 25(19): 3231-3232.
[20]	鲍敏, 甄海宁, 雷贤华. 肺性脑病患者血清神经元特异性烯醇化酶和S 100β蛋白检测的意义[J]. 细胞与分子免疫学杂志, 2011, 27(8): 911-912.
[21]	全国第三次肺心病专业会议. 肺性脑病的诊断和临床分级标准[J]. 中华结核和呼吸杂志, 1981(4): 62.
[22]	何莲, 雷宇. 肺脑合剂联合BiPAP无创呼吸机治疗肺性脑病的疗效观察[J]. 吉林医学, 2011, 32 (21): 4360-4361.
[23]	中华医学会重症医学分会. 慢性阻塞性肺疾病急性加重患者机械通气指南(2007)[J]. 中华急诊医学杂志, 2007, 16(4): 350-357.
[24]	季蓉, 何权瀛. 内源性阿片肽在呼吸调控中的作用[J]. 中华结核和呼吸杂志, 1999, 22(7): 440.
[25]	游古立. 纳洛酮辅治Ⅱ型呼吸衰竭肺性脑病的疗效观察[J]. 临床合理用药, 2009, 2(14): 15-16.
[26]	梁瑜. 纳洛酮联合呼吸兴奋合剂治疗慢性阻塞性肺疾病并肺性脑病临床观察[J]. 蛇志, 2013, 25(1): 31-32.
[27]	曾锤利. 纳洛酮联合无创通气在COPD并发轻、中度肺性脑病治疗中的应用[J]. 重庆医学, 2012, 41(14): 1412- 1413.
[28]	王劭晟, 朱明辉, 保学明. 纳洛酮与甘露醇联合抢救Ⅱ型呼吸衰竭并肺性脑病30例疗效观察[J]. 实用医学杂志, 2007, 23(11): 1725-1726.
[29]	项公强, 王国胜, 王强和. 慢性阻塞性肺疾病患者血清脑特异性蛋白、神经元特异性烯醇化酶水平的变化及临床意义[J]. 实用医学杂志, 2009, 25(19): 3231-3232.
[30]	鲍敏, 甄海宁, 雷贤华. 肺性脑病患者血清神经元特异性烯醇化酶和S 100β蛋白检测的意义[J]. 细胞与分子免疫学杂志, 2011, 27(8): 911-912.