Roca J, Montserrat J M, Rodriguez-Roisin R, Guitart R, Torres A, Agusti A G, Wagner P D
Department of Medicine, Hospital Clinic, Universitat de Barcelona, Spain.
Bull Eur Physiopathol Respir. 1987 May-Jun;23(3):249-54.
It has been hypothesized that naloxone may alter the ventilation-perfusion relationship in patients with chronic obstructive pulmonary disease (COPD) with associated respiratory failure, through the release of hypoxic pulmonary vasoconstriction. To investigate the effects of naloxone on gas exchange, seven clinically stable patients with severe COPD (type B) (forced expiratory volume in one second/forced vital capacity (FEV1/FVC) 38.3 +/- 4.0%) with hypoxaemia and hypercapnia (PaO2 7.6 +/- 0.4 kPa; PaCO2 6.4 +/- 0.3; pH 7.37 +/- 0.02), aged 59.0 +/- 4.6 yr, were studied. Breathing patterns, haemodynamic and conventional and inert gas exchange measurements were made while breathing room air before, during and 60 min after i.v. naloxone infusion. Naloxone and catecholamine plasma levels were also determined. In three subjects (protocol A), measurements were made using increasing concentrations of naloxone (cumulative dose: 54 mg), while the remaining four patients were studied (protocol B) at a fixed concentration of naloxone (cumulative dose: 38 mg). Despite high levels of naloxone (up to 150 ng.ml-1), no significant differences from baseline were observed in any of the measurements, during or after infusion. It is concluded that i.v. naloxone given as described has no effects on pulmonary gas exchange in clinically stable COPD patients with chronic respiratory failure.
据推测，纳洛酮可能通过释放低氧性肺血管收缩作用，改变伴有呼吸衰竭的慢性阻塞性肺疾病（COPD）患者的通气-灌注关系。为研究纳洛酮对气体交换的影响，我们对7例临床稳定的重度COPD（B型）患者进行了研究，这些患者年龄为59.0±4.6岁，一秒用力呼气容积/用力肺活量（FEV1/FVC）为38.3±4.0%，存在低氧血症和高碳酸血症（PaO2 7.6±0.4 kPa；PaCO2 6.4±0.3；pH 7.37±0.02）。在静脉注射纳洛酮前、注射期间及注射后60分钟，让患者呼吸室内空气时，测量其呼吸模式、血流动力学以及传统和惰性气体交换指标。同时还测定了纳洛酮和儿茶酚胺的血浆水平。在3名受试者（方案A）中，使用递增浓度的纳洛酮（累积剂量：54 mg）进行测量，而其余4名患者（方案B）则在固定浓度的纳洛酮（累积剂量：38 mg）下进行研究。尽管纳洛酮水平较高（高达150 ng.ml-1），但在注射期间或注射后，任何测量指标与基线相比均未观察到显著差异。结论是，按所述方式静脉注射纳洛酮对临床稳定的慢性呼吸衰竭COPD患者的肺气体交换无影响。
