高流量氧疗与无创通气在AECOPD序贯治疗中比较研究  

A comparative study on the sequential treatment of AECOPD by high flow nasal cannula oxygenation therapy and noninvasive ventilation

作　　者：蒋光辉[1] 毛媛 唐娅群 邬叔兵 周雯[1] 万建国[1] JIANG Guanghui;MAO Yuan;TANG Yaqun(Department of Critical Care Medicine,the Third Affiliated Hospital of Nanchang University,Nangchang 330008,China)

机构地区：[1]南昌大学第三附属医院重症医学科,南昌330008

出　　处：《江西医药》2020年第8期975-978,992,共5页Jiangxi Medical Journal

基　　金：江西省卫生计生委科技计划,编号20194005。

摘　　要：目的比较经鼻高流量氧疗(HFNC)与无创通气(NIV)用于慢性阻塞性肺疾病拔管后序贯治疗中的效果。方法选择2019年1月至2020年6月南昌大学第三附属医院重症医学科37例接受有创机械通气治疗的慢性阻塞性肺疾病患者,临床出现肺部感染控制窗后,随机分为HFNC序贯治疗组18例和NIV序贯治疗组19例,并对两组患者的一般情况、拔管后动脉血气分析(氧合指数、PCO2)、平均动脉压(MAP)、痰液黏稠度、鼻面部压疮、误吸、再插管、撕拽面罩或鼻氧管发生率等临床指标进行比较分析,计算HFNC组12hROX指数(指脉氧饱和度与吸氧浓度比值除以呼吸频率)。结果两组各时间点氧合指数、PCO2、MAP差异无统计学意义(均P>0.05)。HFNC组各时间点患者痰液黏稠度较NIV组明显降低(均P<0.05),NIV组序贯治疗1周内发生鼻面部压疮4例,而HFNC组无鼻面部压疮发生,两组比较差异有统计学意义(χ^2=4.400,P=0.039)。NIV组患者发生撕摘面罩行为有8例,而HFNC组有2例患者自行摘下氧鼻导管行为,差异有统计学意义(χ^2=4.502,P=0.034)。误吸、再插管发生率两组间差异无统计学意义(P>0.05)。HFNC组12hROX指数与APACHEII评分呈负相关(r=-0.775,P<0.05),ROX指数与插管时间不相关(r=-0.075,P>0.05)。结论⑴HFNC在AECOPD患者拔管后序贯治疗中能够维持或改善呼吸功能,与NIV临床效果相似。此外,HFNC还可以降低痰液黏稠度,降低患者压疮及撕拽行为发生率。⑵12hROX指数与患者APACHEII评分呈中度负相关,而与插管时间无明显相关。Objective To compare the effect of sequential treatment after extubation of chronic obstructive pulmonary disease by high flow nasal cannula oxygen therapy(HFNC)and noninvasive ventilation(NIV).Methods from January 2019 to June 2020,37 patients with chronic obstructive pulmonary disease who were treated by invasive mechanical ventilation in the department of critical medicine of the Third Affiliated Hospital of Nanchang University,the patients were randomly divided into HFNC sequential treatment group(18 cases)and NIV sequential treatment group(19 cases)after pulmonary infection control window,Clinical indexes including general condition,arterial blood gas analysis(oxygenation index,PCO2),mean arterial pressure before extubation and ratio of sputum viscosity,aspiration,re-intubation,pulling mask or nasal oxygen tube after extubation were collected and analyzed.The 12hROX index(the ratio of pulse oxygen saturation to inhaled oxygen concentration divided by respiratory rate)of HFNC group was calculated.Results There was no significant difference in the oxygenation index,PCO2and MAP between the two groups(all P>0.05).The sputum viscosity of HFNC group was lower than that of NIV group significantly(P<0.05).There was no significant difference in the incidence of aspiration,reintubation between the two groups(all P>0.05).NIV group(4cases)higher than HFNC group(0)in the occurrence of pressure sore within 1 week after sequential treatment(χ^2=4.400,P=0.039).There was a significant difference between NIV group(8 cases)and HFNC group(2 cases)in the behavior of removing oxygen nasal catheter(χ^2=4.502,P=0.034).In HFNC group,there was a negative correlation between 12hROX index and APACHEII Score(r=-0.775,P<0.05),but no correlation between 12hROX index and intubation time(r=-0.075,P>0.05).Conclusion⑴HFNC can maintain or improve respiratory function in AECOPD patients after extubation,and its clinical effect is similar to NIV.In addition,HFNC could reduce sputum viscosity,and the incidence of pressure sore and tearing beh

关 键 词：经鼻高流量氧疗 序贯治疗 无创正压通气 肺部感染控制窗 

分 类 号：R563.9[医药卫生—呼吸系统]