经鼻高流量氧疗与无创通气对慢性阻塞性肺疾病急性加重导致的Ⅱ型呼衰疗效对比  

Comparison of therapeutic effects of high-flow nasal cannula oxygen therapy and noninvasive ventilation on type Ⅱ respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease

作　　者：王胜奇[1] 贺明轶[1] 王晶[1] WANG Shengqi;HE Mingyi;WANG Jing(Department of Emergency,Xuanwu Hospital Capital Medical University,Beijing,100054,China)

机构地区：[1]首都医科大学宣武医院急诊科,北京100054

出　　处：《临床急诊杂志》2021年第3期193-198,共6页Journal of Clinical Emergency

摘　　要：目的:探讨经鼻高流量与无创通气对慢性阻塞性肺疾病急性加重引起的Ⅱ型呼吸衰竭的疗效。方法:选取2019年1月-12月期间就诊于我院的慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者105例,随机分为HFNC组50例及NIV组55例。在常规治疗基础上,HFNC组给予经鼻高流量氧疗,NIV组给予无创正压通气,比较两组患者7 d治疗失败率,以及治疗前、治疗后2 h、24 h心率、呼吸频率及血气PO_(2)、PCO_(2)、pH、氧合指数等指标变化,同时比较治疗后24 h患者舒适度。结果:两组7 d累积插管率差异无统计学意义;治疗后2 h、24 h,两组患者PCO_(2)、心率、呼吸频率与治疗前对比有显著下降(P<0.05),pH有显著回升(P<0.05),HFNC组在治疗后24 h PCO_(2)下降程度与pH回升程度均明显小于NIV组(P<0.05);HFNC组舒适度明显高于NIV组(P<0.05)。PCO_(2)≥70 mmHg亚组分析显示HFNC亚组患者7 d累积插管率显著高于NIV亚组(P<0.05);且HFNC亚组对PCO_(2)、pH的持续改善作用差于NIV亚组。结论:在慢性阻塞性肺疾病急性加重导致的Ⅱ型呼吸衰竭患者中,经鼻高流量氧疗可有效较低PCO_(2),同时舒适性高,患者耐受程度较好,可在轻中度高碳酸血症中作为无创通气的替代治疗方式;但在重度高碳酸血症中应用经鼻高流量氧疗有增加插管率的风险。Objective: To investigate the effects of high-flow nasal cannula oxygen therapy(HFNC) and noninvasive ventilation(NIV) on type Ⅱ respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease. Methods: One hundred and five patients with type Ⅱ respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease were randomly divided into HFNC group(n=50) and NIV group(n=55). On the basis of routine treatment, HFNC group was given high-flow nasal cannula oxygen therapy, while NIV group was given noninvasive positive pressure ventilation. The intubation rate at day 7, as well as heart rate, respiratory frequency, PO_(2), PCO_(2), pH, oxygenation index at baseline and 2 hours, 24 hours after treatment between the two groups were compared. Comfort scores was compared at 24 hours after treatment. Results: There was no statistical difference in the cumulative intubation rate between the two groups at day 7.Compared to those at baseline, PCO_(2), heart rate and respiratory rate decreased significantly(P<0.05), while pH increased significantly(P<0.05) in both groups at 2, 24 hours after treatment. The extent of variation of these 2 parameters was greater in the NIV group(P<0.05)than that in HFNC group.The comfort score was significantly higher in HFNC group than that in NIV group(P<0.05). The subgroup analysis(PCO_(2)≥70 mmHg) showed that the cumulative intubation rate of HFNC subgroup was significantly higher than that of NIV subgroup(P<0.05), and the continuous improvement of PCO_(2)and pH in HFNC subgroup was worse than that in NIV subgroup. Conclusion: HFNC can effectively reduce PCO_(2)in patients with type Ⅱ respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease with higher comfort and better patient acceptance. HFNC can be used as an alternative treatment of noninvasive ventilation in mild to moderate hypercapnia.But in severe hypercapnia, HFNC might increase the risk of intubation.

关 键 词：经鼻高流量 无创通气 慢性阻塞性肺疾病急性加重 呼吸衰竭 

分 类 号：R563.9[医药卫生—呼吸系统]