慢性阻塞性肺疾病患者拔管后序贯经鼻高流量氧疗的效果研究  

Effect of sequential nasal high flow oxygen therapy after extubation in patients with chronic obstructive pulmonary disease

作　　者：林怀印 付会文[1] 赵智东 郭安[1] 孙涛[1] LIN Huaiyin;FU Huiwen;ZHAO Zhidong;GUO An;SUN Tao(Department of Intensive Care Unit,Hengshui Second People′s Hospital,Hengshui,Hebei 053000,China)

机构地区：[1]河北省衡水市第二人民医院重症医学科

出　　处：《检验医学与临床》2019年第12期1646-1649,共4页Laboratory Medicine and Clinic

基　　金：河北省衡水市科技计划项目(2017014040Z)

摘　　要：目的 探讨慢性阻塞性肺疾病(COPD)患者拔管后给予序贯经鼻高流量氧疗的治疗效果。方法 选择2015年6月至2017年11月在该院进行治疗的COPD患者84例,按照随机数字表法将患者分为对照组与观察组,每组42例。对照组患者在拔管后给予无创机械通气,观察组患者在拔管后给予序贯经鼻高流量氧疗,对两组治疗效果进行比较分析。结果 治疗后,观察组患者的肺功能指标一秒用力呼气容积(FEV1),一秒用力呼气容积占用力肺活量比值的预测值(FEV1%预测值),以及FEV1与用力肺活量的比值(FEV1/FVC)、氧合指数高于对照组,差异均有统计学意义(P<0.05)。两组患者的再插管率、误吸发生率、压疮发生率、谵妄发生率、28d病死率比较,差异均无统计学意义(P>0.05);对照组的重症监护室停留时间长于观察组[(15.38±0.87)dvs.(13.37±0.48)d],差异有统计学意义(t=13.110,P<0.05);观察组的治疗耐受度评分[(1.27±0.41)分]低于对照组[(2.73±0.43)分],差异有统计学意义(t=15.925,P<0.05)。结论 COPD患者在拔管后给予经鼻高流量氧疗的序贯治疗,可以明显改善患者的肺功能与血气指数,提升患者的治疗耐受度。Objective To investigate the effect of sequential transnasal high-flow oxygen therapy after extubation in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 84 patients with COPD who were treated at Hengshui Second People′s Hospital from June 2015 to November 2017 were selected.Patients were divided into control group and observation group according to a random number method,and each group was 42 patients.Patients in the control group were given non-invasive mechanical ventilation after extubation,and patients in the observation group were given high-flow nasal oxygen therapy after extubation,effects of treatment were compared. Results After treatment,the FEV1,FEV1% predictive value,FEV1/FVC,and oxygenation index of the observation group were significantly higher than that of the control group ( P <0.05).Re-intubation rate,aspiration rate,pressure ulcer incidence,hernia incidence and 28-day mortality rates between the two groups were not statistically significant ( P >0.05).The intensive care unit stayed in the control group was longer than the observation group [( 15.38± 0.87)d vs .(13.37±0.48)d],and the difference was statistically significant ( t =13.110, P <0.05).The treatment comfort of the observation group (1.27±0.41) was significantly lower than the control group (2.73±0.43),and the difference was statistically significant ( t =15.925, P <0.05). Conclusion Continuous treatment of patients with COPD who underwent nasal high-flow oxygen therapy after extubation could improve lung function and blood gas index,as well as improve patient tolerance.

关 键 词：慢性阻塞性肺疾病 经鼻高流量氧疗 无创机械通气 

分 类 号：R563[医药卫生—呼吸系统]