目的观察纳洛酮联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效及安全性。方法将86例慢性阻塞性肺疾病合并呼吸衰竭患者随机分为对照组43例和试验组43例。对照组予以无创正压通气治疗,每次4h,tid;试验组在对照组治疗的基础上,予以静脉注射纳洛酮,首剂0.8 mg,15 min后,将纳洛酮2 mg在24 h内持续静脉泵入,连用3 d。2组患者疗程均为1周。比较2组患者的临床疗效、血气指标的变化情况,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为93.02%(40/43例)和74.42%(32/43例),差异有统计学意义(P<0.05)。治疗后,试验组与对照组的血氧分压分别为(85.16±7.43),(75.07±7.27)mm Hg;血氧饱和度分别为(93.67±1.86)%,(85.05±1.62)%;p H值分别为(7.42±0.15),(7.29±0.13);二氧化碳分压分别为(39.19±3.81),(48.05±6.28)mm Hg,差异有统计学意义(P<0.05)。2组患者的药物不良反应主要为发热和呼吸抑制,试验组和对照组的药物不良反应发生率分别为4.65%和6.98%,差异无统计学意义(P>0.05)。结论纳洛酮联合无创正压通气治疗可显著提高慢性阻塞性肺疾病合并呼吸衰竭患者的临床效果,有效地改善患者的血气指标,且不增加药物不良反应的发生率。 Objective To observe the clinical efficacy and safety of naloxone in combination with noninvasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Methods A total of 86 patients with chronic obstructive pulmonary disease and respiratory failure were randomly divided into control group (43 cases) and experimental group (43 cases). The control group was treated with noninvasive positive pressure ventilation, each time being 4h, tid. On the basis of the control group, the experimental group was given naloxone intravenously. After the first dose of 0.8 mg for 15 min, naloxone 2 mg Continuous intravenous infusion, once every 3 d. Two groups of patients were treated for 1 week. The clinical efficacy, changes of blood gas index, and the incidence of adverse drug reactions were compared between the two groups. Results After treatment, the total effective rates of the experimental group and the control group were 93.02% (40/43 cases) and 74.42% (32/43 cases) respectively, the difference was statistically significant (P <0.05). After treatment, the partial pressure of oxygen in the experimental group and the control group were (85.16 ± 7.43) and (75.07 ± 7.27) mm Hg respectively; the oxygen saturations were (93.67 ± 1.86)% and (85.05 ± 1.62)%, respectively; p H values ​​were (7.42 ± 0.15) and (7.29 ± 0.13), respectively. The partial pressures of carbon dioxide were (39.19 ± 3.81) and (48.05 ± 6.28) mm Hg, respectively, with statistical significance (P <0.05). Adverse drug reactions in the two groups were mainly fever and respiratory depression. The incidences of adverse drug reactions in the two groups were 4.65% and 6.98%, respectively, with no significant difference (P> 0.05). Conclusion Naloxone combined with noninvasive positive pressure ventilation can significantly improve the clinical efficacy of patients with chronic obstructive pulmonary disease and respiratory failure, effectively improve the blood gas index of patients without increasing the incidence of adverse drug reactions.