经鼻高流量氧疗在慢性阻塞性肺疾病急性加重中的临床应用  

Clinical application of nasal high flow cannula in acute exacerbation of chronic obstructive pulmonary disease

作　　者：张珂[1] 刘艳 冯慧[1] 尘丹 刘凤霞 刘景刚[1] Zhang Ke;Liu Yan;Feng Hui;Chen Dan;Liu Fengxia;Liu Jinggang(Department of Critical Care Medicine,Huxi Hospital(Shanxian Central Hospital)Affiliated to Jining Medical College,Shandong Shanxian 274300,China)

机构地区：[1]济宁医学院附属湖西医院(单县中心医院)重症医学科,山东单县274300

出　　处：《中国医师进修杂志》2020年第4期289-293,共5页Chinese Journal of Postgraduates of Medicine

基　　金：济宁医学院教师科研扶持基金(JYFC2018FKJ095、JYFC2018FKJ062)。

摘　　要：目的探索经鼻高流量氧疗(HFNC)在慢性阻塞性肺疾病急性加重期患者中的临床应用价值。方法以2017年6月至2018年6月济宁医学院附属湖西医院(单县中心医院)收治的61例慢性阻塞性肺疾病急性加重期患者为临床研究对象,使用随机数字表法将患者分为对照组和治疗组,对照组31例,治疗组30例,两组患者均常规给予抗感染、抗炎、祛痰、解痉、平喘、抗凝、营养支持等治疗。对照组给予常规低流量氧疗,治疗组给予经鼻高流量氧疗。观察两组患者治疗开始前及治疗后12、24、48和72 h各时间点动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、肺动脉收缩压(PSAP)、右室压力最大上升速率(dp/dt)的变化,以及7 d内无创机械通气及有创机械通气的应用率情况。结果两组患者治疗前PaO2、PaCO2、PSAP及dp/dt比较差异均无统计学意义(P>0.05)。治疗组较对照组,治疗后各时间点PaO2均降低[(54.37±5.39)mmHg(1 mmHg=0.133 kPa)比(57.77±6.06)mmHg、(61.87±5.20)mmHg比(65.03±4.91)mmHg、(66.93±6.59)mmHg比(72.58±7.13)mmHg、(70.20±8.18)mmHg比(75.55±7.37)mmHg,P<0.05];PaCO2均降低[(57.97±6.18)mmHg比(61.84±6.20)mmHg、(51.27±4.53)mmHg比(55.77±5.87)mmHg、(48.57±5.37)mmHg比(51.55±4.62)mmHg、(44.70±5.40)mmHg比(47.68±5.86)mmHg,P<0.05];PSAP均降低[(50.80±6.94)mmHg比(54.55±6.58)mmHg、(48.70±6.22)mmHg比(52.55±6.91)mmHg、(45.33±7.51)mmHg比(49.19±6.40)mmHg、(41.23±9.22)mmHg比(45.94±7.35)mmHg,P<0.05];dp/dt均增高[(403.77±109.43)mmHg/s比(345.39±112.50)mmHg/s、(429.83±102.56)mmHg/s比(369.77±110.55)mmHg/s、(483.43±105.20)mmHg/s比(426.48±107.27)mmHg/s、(532.43±107.01)mmHg/s比(473.74±105.00)mmHg/s,P<0.05];两组对比治疗组7 d内无创/有创机械通气的应用率更低(P<0.05)。结论HFNC对慢性阻塞性肺疾病Ⅱ级的患者有更好的临床疗效,有助于心肺功能的改善。Objective To explore the clinical value of nasal high flow oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods From June 2017 to June 2018,61 patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)admitted to the Huxi Hospital(Shanxian Central Hospital)Affiliated to Jining Medical College were taken as the clinical research objects.The patients were divided into control group and treatment group by using the random number table method with 31 patients in control group and 30 patients in treatment group.They all treated with anti-infection,anti-inflammation,expectoration,spasmolysis,asthma relief,anticoagulation and nutritional support.The control group was given conventional low flow oxygen therapy,while the treatment group was given nasal high flow oxygen therapy.The changes of partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),pulmonary artery systolic pressure(PSAP),right ventricular pressure maximum rise rate(dp/dt)and the application rate of non-invasive and invasive mechanical ventilation within 7 d were observed before and 12,24,48 and 72 h after treatment.Results Before treatment,PaO2,PaCO2,PSAP and dp/dt of patients in the two groups showed no statistical difference,indicating comparability between groups.Compared with the control group,the PaO2 in the treatment group decreased at all time points after treatment[(54.37±5.39)mmHg(1 mmHg=0.133 kPa)vs.(57.77±6.06)mmHg,(61.87±5.20)mmHg vs.(65.03±4.91)mmHg,(66.93±6.59)mmHg vs.(72.58±7.13)mmHg,(70.20±8.18)mmHg vs.(75.55±7.37)mmHg,P<0.05].PaCO2 decreased[(57.97±6.18)mmHg vs.(61.84±6.20)mmHg,(51.27±4.53)mmHg vs.(55.77±5.87)mmHg,(48.57±5.37)mmHg vs.(51.55±4.62)mmHg,(44.70±5.40)mmHg vs.(47.68±5.86)mmHg,P<0.05].PSAP all decreased[(50.80±6.94)mmHg vs.(54.55±6.58)mmHg,(48.70±6.22)mmHg vs.(52.55±6.91)mmHg,(45.33±7.51)mmHg vs.(49.19±6.40)mmHg,(41.23±9.22)mmHg vs.(45.94±7.35)mmHg,P<0.05].Dp/dt all increased[(403.77±109.43)mmHg/s vs.(345.39±112.50)mmH

关 键 词：肺疾病 慢性阻塞性 经鼻高流量 氧疗 

分 类 号：R563[医药卫生—呼吸系统]