目的 探讨细辛脑注射液联合纳络酮治疗慢性肺心病呼吸衰竭的临床效果。方法 选取2016年6月-2017年12月衡水市第二人民医院收治的98例慢性肺心病呼吸衰竭患者，随机分为对照组和治疗组，每组各49例。对照组给予盐酸纳洛酮注射液，以0.8 mg为首次负荷剂量加入生理盐水15 mL静脉推注，再将4.0 mg加入生理盐水250 mL均匀混合后缓慢持续静脉滴注，1次/d。治疗组在对照组治疗基础上静脉滴注细辛脑注射液，40 mg加入5%葡萄糖液250 mL充分稀释后给药，1次/d。两组均连续治疗14 d。观察两组的临床疗效，比较两组临床症状缓解时间。比较两组治疗前后动脉血氧/二氧化碳分压（pO₂和pCO₂）、酸碱度（pH）、血氧饱和度（SaO₂）、血浆黏度（PV）、红细胞聚集指数（RCAI）、红细胞比容（HCT）、红细胞沉降率（ESR）、肺动脉收缩压（PASP）、右室舒张末期内径（RVd）、脑钠肽（BNP）、心肌肌钙蛋白I（cTnI）、单核细胞趋化蛋白-1（MCP-1）、白细胞介素（IL）-18、血清血管性血友病因子（vWF）和内皮素-1（ET-1）水平。结果 治疗后，对照组和治疗组的总有效率分别为77.55%、91.84%，两组比较差异有统计学意义（P<0.05）。治疗后，治疗组咳嗽、气促、心悸、肺啰音、水肿临床症状缓解时间均显著短于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组pO₂、pH、SaO₂值均较治疗前显著增加，但pCO₂、PASP、RVd、BNP、cTnI、PV、RCAI、HCT、ESR、MCP-1、IL-18、ET-1、vWF显著减少，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组pO₂、pH、SaO₂值高于对照组，pCO₂、PASP、RVd、BNP、cTnI、PV、RCAI、HCT、ESR、MCP-1、IL-18、ET-1、vWF低于对照组，两组比较差异有统计学意义（P<0.05）。结论 细辛脑注射液联合纳络酮治疗慢性肺心病呼吸衰竭具有较好的临床疗效，可有效减轻患者症状，改善心肺功能，调节血流变状态，抑制炎性反应，保护内皮功能，具有一定的临床推广应用价值。

Objective To explore the clinical effect of Asarone Injection combined with naloxone in treatment of chronic pulmonary heart disease with respiratory failure. Methods Patients (98 cases) with chronic pulmonary heart disease with respiratory failure in the Second People's Hospital of Hengshui from June 2016 to December 2017were randomly divided into control (49 cases) and treatment (49 cases) groups. Patients in the control group were administered with Naloxone Hydrochloride Injection, initial dosage of 0.8 mg added with normal saline 15 mLwhich was intravenous injected, then 4.0 mg added with normal saline 250 mL which was slowly continuous intravenous drip, once daily. Patients in the treatment group were iv administered with Asarone Injection on the basis of the control group, 40 mg added with 5% glucose liquid 250 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and remission times of clinical symptom in two groups were compared. The changes of pO₂, pCO₂, pH, SaO₂, PV, RCAI, HCT, ESR, PASP, RVd, BNP, cTnI, MCP-1, IL-18, vWF, and ET-1 in two groups were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 77.55% and 91.84%, respectively, and there was difference between two groups (P < 0.05). After treatment, remission time of cough, breath, heart palpitation, lung, and edema in the treatment group were shorter than those in the control group, and there was difference between two groups (P < 0.05). After treatment, pO₂, pH, and SaO₂ in two groups were significantly increased, but pCO₂, PASP, RVd、BNP, cTnI, PV, RCAI, HCT, ESR, MCP-1, IL-18, ET-1, and vWF in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, pO₂, pH, and SaO₂ in the treatment group were higher than those in the treatment group, but pCO₂, PASP, RVd、BNP, cTnI, PV, RCAI, HCT, ESR, MCP-1, IL-18, ET-1, and vWF were lower than those in the treatment group, and there was difference between two groups (P < 0.05). Conclusion Asarone Injection combined with naloxone has remarkable clinical effect in treatment of chronic pulmonary heart disease with respiratory failure, and can effectively alleviate symptoms, improve the cardiopulmonary function, and can regulate the blood flow, suppress the inflammatory response, also can protect the endothelial function, which has a certain clinical application value.

衡水市重点研发计划项目（2017014040Z）