两种早期撤机序贯辅助通气方法对AECOPD患者炎症指标及临床结局影响的比较  

Comparison of the effects of two early withdrawal sequential assisted ventilation methods on inflammatory indicators and clinical outcome in AECOPD patients

作　　者：杨小雪 仲轶 薛婷 叶英 许铁 燕宪亮 YANG Xiaoxue;ZHONG Yi;XUE Ting;YE Ying;XU Tie;YAN Xianliang(Emergency Medicine Department of the Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing Jiangsu,211100,China)

机构地区：[1]南京医科大学附属江宁医院急诊科,江苏南京211100 [2]徐州医科大学附属医院急诊医学科,江苏徐州221002 [3]徐州市急诊医学重点实验室&江苏省卫生应急研究所,江苏徐州221002

出　　处：《中国急救复苏与灾害医学杂志》2022年第2期208-211,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家青年科学基金(编号:31800810)。

摘　　要：目的比较早期撤机序贯经鼻高流量氧疗(HFNC)和无创正压辅助通气(NPPV)对慢性阻塞性肺疾病急性加重(AECOPD)患者炎症指标和临床结局影响的差异,为临床序贯辅助通气模式的选择提供参考。方法选取2019年12月—2020年12月在徐州医科大学附属医院EICU住院并接受有创机械通气的AECOPD患者为研究对象,满足肺部感染控制窗(PIC-W)后按随机数字表法分为HFNC组和NPPV组,分别给予HFNC和NPPV序贯通气治疗。收集患者一般资料、拔管前24 h最差APACHEII评分及SOFA评分;检测拔管前1 h,拔管后24、72 h白细胞计数(WBC),超敏C反应蛋白(CRP)和降钙素原(PCT)浓度;计算患者呼吸困难评分;统计拔管后HFNC治疗时间及NPPV治疗时间、院内感染发生率、再插管率、ICU住院时间、总住院时间、28 d病死率。结果两组各有35例纳入最终的统计。与拔管前1 h相比,两组患者拔管后24 h和72 h的血浆CRP、PCT浓度,以及72 h WBC计数显著降低(P<0.05);拔管后72 h时HFNC组患者WBC、CRP、PCT明显低于NPPV组,差异有统计学意义(P<0.05)。拔管后24 h和72 h,HFNC组患者呼吸困难评分低于NPPV组,差异有统计学意义(P<0.05)。HFNC组患者治疗时间、院内感染发生率低于NPPV组,差异有统计学意义(P<0.05);两组再插管率、28 d病死率,ICU住院时间和总住院时间比较差异无统计学意义(P>0.05)。结论以PIC-W为撤机时间点,对AECOPD患者实施撤机序贯通气治疗,HFNC序贯通气在降低AECOPD撤机患者炎症指标,改善患者呼吸困难,降低院内感染发生率,缩短无创呼吸支持治疗时间等方面要优于NPPV序贯通气,值得推广并优先选用。Objective To compare the differences in the effects of sequential transnasal high-flow nasal cannula oxygen therapy(HFNC)and noninvasive positive pressure assisted ventilation(NPPV)on inflammatory indicators and clinical outcome in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),to provide a reference for the choice of clinically sequential adjuvant ventilation patterns.Methods AECOPD patients with invasive mechanical ventilation admitted to EICU of the Affiliated Hospital of Xuzhou Medical University,from December 2019 to December 2020,were selected as the study subjects,after meeting the lung infection control window(PIC-W),the patients were divided into HFNC and NPPV groups according to randomized digital table,and HFNC and NPPV sequential ventilative treatment were given,respectively.General information,the worst scores of APACHE II and SOFA of the patients in 24h before extubation were collected;WBC counts,the concentration of CRP and PCT were measured at 1h before extubation,24 h and 72 h after extubation.The dyspnea score of the patients in two groups were calculated.The HFNC treatment time and NPPV treatment time after extubation,incidence of nosocomial infection,reintubation rate,length of ICU stay,total length of hospital stay,28-day mortality were recorded.Results 35 cases were included in the final statistics in the each of both groups.Compared with at 1h before extubation,plasma concentration of CRP,PCT at 24 h and 72 h after extubation,and WBC count at 72 h after extubation in the two groups were decreased significantly;WBC count,plasma concentration CRP and PCT of the patients in HFNC group were significantly lower than those in NPPV group,the difference was statistically significant(P<0.05).The dyspnea score of patients in HFNC group at 24 h and 72 h after extubation was lower than in NPPV group,the difference was statistically significant(P<0.05).The duration of treatment and the incidence of nosocomial infection of the patients in HFNC group were lower than thos

关 键 词：肺部感染控制窗 慢性阻塞性肺疾病急性加重 经鼻高流量氧疗 无创正压通气 

分 类 号：R45[医药卫生—治疗学]