作　　者： (郑家群）;

机构地区： 四川大学华西广安医院呼吸科,四川广安638000

出　　处： 《中国医学前沿杂志（电子版）》 2017年第7期136-140,共5页

摘　　要： 目的分析纳洛酮联合双水平正压通气对慢性阻塞性肺疾病急性发作(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者氧化应激和血清中枢神经系统相关细胞因子水平的影响。方法选取2013年10月至2016年10月本院收治的72例AECOPD患者为研究对象,采用随机数表法将其分为观察组和对照组,每组各36例。给予对照组患者双水平正压通气,观察组患者在对照组治疗基础上给予纳洛酮治疗。比较两组患者治疗前和治疗后7天血气分析指标[动脉血p H、动脉血氧分压(arterial partial pressure of oxygen,PaO_2)及动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_2)],氧化应激相关因子[血浆丙二醛(Malondialdehyde,MDA)、血清总超氧化物歧化酶(total superoxide dismutase,T-SOD)、血浆8-异前列腺素F2α(8-iso Prostaglandin F2α,8-iso-PGF2α)],血清神经系统相关细胞因子[血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)、S100β及髓鞘碱性蛋白(myelin basic protein,MBP)]水平。结果治疗后两组患者血气指标较治疗前均有所好转,动脉血pH和PaO_2均显著升高(P<0.05),PaCO_2均显著降低(P<0.001)。治疗后,观察组患者动脉血pH和PaO_2均高于对照组,仅PaO_2组间比较具有显著差异(P<0.001),PaCO_2低于对照组(P<0.05)。治疗后两组患者血浆MDA和8-iso-PGF2α水平均显著低于治疗前(P<0.05),T-SOD水平显著高于治疗前(P<0.001);观察组患者血浆MDA和8-iso-PGF2α水平均显著低于对照组(P<0.001),T-SOD水平显著高于对照组(P<0.001)。治疗后,两组患者血清NSE、S100β及MBP水平均显著低于治疗前(P<0.05);观察组患者血清NSE、S100β及MBP水平均显著低于对照组(P<0.001)。结论纳洛酮联合双水平正压通气能够改善AECOPD患者血气分析指标,减轻机体氧化应激反应,保护中枢神经系统功能。 Objective To study the therapeutic effect of Naloxone combined with bi-level positive airway pressure （BiPAP） on oxdative stress and serum cytokines of central nervous system of patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.Method 72 patients with AECOPD who were treated in our hospital from October 2013 to October 2016 were enrolledin this study and randomly divided into observation group and control group, 36 cases in each group. Control group patients were treated with BiPAP mode, and observation group patients were treated with Naloxone besides BiPAP. The blood gas analysis results [arterial blood pH, arterial partial pressure of oxygen （PaO2） and arterial partial pressure of carbon dioxide （PaCO2）], the oxidative stress related cytokines [the plasma malondialdehyde （MDA）, the serum total superoxide dismutase （T-SOD）, the plasma 8-iso Prostaglandin F2α （8-iso-PGF2α）], and the serum nervous system related cytokines [neuron-specific enolase （NSE）, S100β and myelin basic protein （MBP）] were compared before and 7 days after treatment between the two groups.Result After treatment, the blood gas indexes of the two groups were better than those before treatment, the pH and PaO2 of the two groups were significantly increased （P〈0.05）, while the PaCO2 were significantly decreased after treatment （P〈0.001）. After treatment, the pH and PaO2 of observation group was higher than control group, while the difference of PaO2 between the two groups was statistically significant （P〈0.001）, and the PaCO2 was significantly lower than control group （P〈0.05）. The levels of plasma MDA and 8-iso-PGF2α of the two groups were significantly decreased （P〈0.05）, while the serum T-SOD was significantly increased after treatment （P〈0.001）. After treatment, the levels of plasma MDA and 8-iso-PGF2α of observation group were significantly lower than control （P〈0.001）, but the serum T-SOD level was significantly higher than c

关 键 词： 慢性阻塞性肺疾病急性发作 氧化应激 中枢神经系统 细胞因子