目的 系統(tǒng)評價納洛酮聯(lián)用無創(chuàng)正壓通氣（NIPPV）治療慢性阻塞性肺病急性加重（AECOPD）合并呼吸衰竭的有效性和安全性，為臨床提供循證醫(yī)學(xué)證據(jù)。方法 計算機檢索PubMed、Medline、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫（CBM）、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、維普中文科技期刊數(shù)據(jù)庫（VIP）和萬方等數(shù)據(jù)庫，收集納洛酮聯(lián)用NIPPV對比單用NIPPV治療AECOPD合并呼吸衰竭的隨機對照研究（RCTs），檢索時限均為2000年1月至2018年1月，提取有效數(shù)據(jù)后采用RevMan 5.2軟件進行Meta-分析。結(jié)果 納入18篇RCTs，1 731例患者。Meta-分析結(jié)果顯示，相對于單用NIPPV，納洛酮聯(lián)用NIPPV能顯著提高臨床有效率［RR=1.22，95%CI （1.16~1.28），P<0.01］、降低住院死亡率［RR=0.37，95%CI（0.16~0.86），P=0.02］和再次插管率［RR=0.24，95%CI（0.12~0.48），P<0.01］；顯著增加氧分壓［MD=9.75，95%CI（8.27~11.27，P<0.01）和血氧飽和度［MD=5.32，95%CI（3.14~7.50），P<0.01］，顯著降低二氧化碳分壓［MD=-6.99，95%CI（-7.68~-6.29），P<0.01］；降低住院時間［MD=-3.62，95%CI（-4.07~-3.06，P<0.01）］。兩組均未發(fā)生不良反應(yīng)。結(jié)論 對于AECOPD合并呼吸衰竭患者，納洛酮聯(lián)用NIPPV能顯著提高臨床療效，降低死亡率和再次插管率，改善血氣分析指標，縮短住院時間。

Objective To systematically review the efficacy and safety of naloxone combined with noninvasive positive pressure ventilation (NIPPV) for treatment of acute exacerbation of chronic obstructive(AECOPD) with respiratory failure, and provide the evidence-based medical for clinical practice. Methods Databases including PubMed, Medline, CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about naloxone combined with NIPPV vs alone NIPPV in the treatment of AECOPD with respiratory failure from January 2000 to January 2018. After extracting valid data, Meta-analysis was conducted by RevMan 5.2 software. Results A total of 18 RCTs (1 731 patients) were included. Meta-analysis showed that, compared to the alone NIPPV, naloxone combined with NIPPV could improve the clinical effective rate[RR=1.22, 95%CI (1.16-1.28, P<0.01)], reduce the in-hospital mortality[RR=0.37, 95%CI (0.16-0.86), P=0.02], and the rate of re-intubation[RR=0.24, 95%CI (0.12-0.48), P<0.01]; significantly increased PaO₂[MD=9.75, 95%CI (8.27-11.27), P<0.01] and SaO₂[MD=5.32, 95%CI (3.14-7.50), P<0.01], significantly reduced the PaCO₂[MD=-6.99, 95%CI (-7.68--6.29), P<0.01]; and reduce the time of hospitalization[MD=-3.62, 95%CI (-4.07--3.06), P<0.01]. There was no adverse reaction in two groups. Conclusion For patients with AECOPD combined with respiratory failure, naloxone combined with NIPPV can significantly improve the clinical efficacy, reduce mortality and re-intubation rate, improve blood gas analysis index, and shorten the time of hospitalization.