经鼻高流量氧疗在慢性阻塞性肺疾病急性加重患者有创呼吸机序贯治疗中的临床效果  

Clinical efficacy of sequential therapy from invasive ventilator to high-flow nasal cannula oxygen therapy of patients with acute exacerbations of chronic obstructive pulmonary disease

作　　者：於江泉 郑瑞强[1,2] 朱进 林华[1,2] 陈齐红[1,2] 邵俊 Yu Jiangquan;Zheng Ruiqiang;Zhu Jin;Lin Hua;Chen Qihong;Shao Jun(Clinical Medical College,Yangzhou University,Yangzhou 225001,China;Department of Critical Care Medicine,Northern Jiangsu People′s Hospital,Yangzhou 225001,China;Department of Critical Care Medicine,No.4 People′s Hospital of Taizhou,Taizhou 225300,China)

机构地区：[1]扬州大学临床医学院,江苏扬州225001 [2]江苏省苏北人民医院重症医学科,江苏扬州225001 [3]泰州市第四人民医院重症医学科,225300

出　　处：《中华重症医学电子杂志》2019年第3期213-218,共6页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：江苏省卫生计生委面上项目(H201660);江苏省青年医学人才项目(QNRC2016318);江苏省扬州市社会发展计划项目(YZ2018075)

摘　　要：目的探讨经鼻高流量(HFNC)氧疗在慢性阻塞性肺疾病急性加重(AECOPD)患者有创呼吸机序贯治疗中的效果是否与无创呼吸机(NIV)类似.方法将苏北人民医院重症医学科(ICU)2017年9月至2018年4月连续收治的因COPD急性加重需气管插管行有创呼吸机治疗的患者纳入研究,经治疗患者病情改善出现"病情缓解窗"后,将患者随机分为HFNC组和NIV组,主要观察终点是患者48h内再插管率,次要观察终点是ICU住院时间以及不良事件发生率.结果共计35例患者纳入分析,HFNC组18例,NIV组17例.48h内HFNC组3例患者(16.7%)、NIV组2例患者(11.8%)再插管,2组比较,差异无统计学意义(P>0.05);ICU住院时间HFNC组较NIV组明显降低[(10.4±1.8)dvs(14.2±1.1)d,t=-2.549,P=0.023],不良事件HFNC组发生1例(5.6%)、NIV组5例(29.4%),2组比较差异有统计学意义(P<0.01).结论以"病情缓解窗"为切换点实施有创呼吸机-经鼻高流量序贯通气策略与无创序贯通气治疗效果相似,且可缩短ICU住院时间,显著减少无创通气不良事件的发生.Objective To investigate the effect of high-flow nasal cannula (HFNC) oxygen therapy in sequential therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The AECOPD patients with invasive ventilator treatment in our department from January 2017 to April 2018 were observed. DRW (Disease Relieved Window) was defined as the time point when state of illness was under controlled. At DRW the patients were randomly divided into HFNC group and NIV group. We recored the re-intubation within 48 hours, ICU length of stay (LOS) and incidence of adverse events. Results 35 patients were enrolled with 18 patients in the HFNC group and 17 patients in the NIV group. In 48 hours, 3 patients (16.7%) in HFNC group and 2 patients (11.8%) in NIV group were re-intubated (P > 0.05). ICU LOS of HFNC was significantly shorter than that in NIV group [(10.4±1.8) d vs (14.2±1.1) d, t=-2.549, P=0. 023]. There were 1 case (5.6%) of adverse events in HFNC group and 5 cases (29.4%) in NIV group (P < 0.01). Conclusion High-flow nasal cannula is similar in efficacy to noninvasive in sequential ventilation, and it is associated with shorter ICU LOS and less adverse events.

关 键 词：慢性阻塞性肺疾病 急性加重 经鼻高流量氧疗 序贯治疗 

分 类 号：R563.9[医药卫生—呼吸系统]