AECOPD患者早期撤机序贯经鼻高流量湿化氧疗与无创正压通气对炎症指标及临床结局的影响  

Effects of sequential nasal high-flow humidification oxygen therapy with non-invasive positive pressure ventilation on inflammatory markers and clinical outcomes in AECOPD patients with early extubation

作　　者：卓越 杨小雪 李丽 许铁 吕兰欣 叶英 ZHUO Yue;YANG Xiaoxue;LI Li;XU Tie;LYU Lanxin;YE Ying(Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院急诊医学科,江苏徐州221002 [2]徐州医科大学,徐州医科大学附属医院徐州市急诊医学重点实验室,江苏徐州221002

出　　处：《中国急救复苏与灾害医学杂志》2022年第4期486-490,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家青年科学基金(编号:31800810)。

摘　　要：目的探讨慢性阻塞性肺疾病急性加重(AECOPD)患者以肺部感染控制窗(PIC-W)为切换点撤机序贯经鼻高流量湿化氧疗(HFNC)与序贯无创正压通气(NPPV)对炎症指标及预后的影响。方法选取徐州医科大学附属医院急诊重症医学科2019年12月—2020年12月收治的AECOPD有创机械通气患者70例,满足PIC窗后按随机数字表法分为HFNC组(n=35)和NPPV组(n=35),分别在常规治疗基础上予HFNC和NPPV序贯通气治疗。收集患者一般资料、拔管前24h最差APACHE II评分及SOFA评分;检测拔管24 h、72 h白细胞计数(WBC)、超敏C反应蛋白(CRP)、降钙素原(PCT);观察两组拔管后2 h、24 h、72 h氧合指数、动脉血PCO_(2)以及生理指标;记录患者不同时间点呼吸困难评分;统计临床结局/并发症相关指标(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)。结果与拔管前相比,两组拔管后24 h CRP、PCT及72h WBC、CRP、PCT较拔管前下降,拔管后72 h HFNC组WBC、CRP、PCT明显低于NPPV组,差异有统计学意义(P<0.05);与拔管前相比,两组拔管后72 h氧合指数均明显改善,PaCO_(2)明显下降,差异有统计学意义(P<0.05);两组拔管后72 h RR及HR均较拔管前降低,而HFNC组拔管后72 h RR低于NPPV组,差异有统计学意义(P<0.05);不同时间点HFNC组患者呼吸困难评分均低于NPPV组;HFNC组治疗时间、院内感染发生率均低于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AECOPD患者以PIC-W为撤机切换点序贯HFNC或NPPV均能提高氧合指数,降低PaCO_(2)。HFNC较NPPV能够减少PCT、CRP等炎性因子释放,降低患者呼吸频率,改善患者呼吸困难,缩短无创治疗时间并降低院内感染发生率,可应用于AECOPD撤机患者。Objective To investigate the Pulmonary infection control window(PAC-W)as switching point for patients with acute exacerbation of chronic obstructive Pulmonary disease(AECOPD)using high-flow nasal cannula oxygen therapy(HFNC)and sequential non-invasive positive pressure ventilation(NPVP)on inflammatory markers and prognosis.Methods A total of 70 patients with invasive mechanical ventilation AECOPD admitted to the Department of Emergency Critical Care Medicine,Affiliated Hospital of Xuzhou Medical University from December 2019 to December 2020 were selected as the research objects.After meeting PIC window,they were divided into HFNC group(n=35)and NPPV group(n=35)according to random number table method.HFNC and NPPV were given sequential treatment on the basis of conventional treatment.General information,the worst APACHE Ⅱ score at 24 h and SOFA score before extubation were Collected;WBC,CRP and PCT were detected at 24 h and 72 h after extubation.Oxygenation index,arterial blood PaCO_(2) and physiological indexes were observed at 2 h,24 h and 72 h after extubation in both groups.The dyspnea score were recorded at different time points.The clinical outcome/complication related indicators(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 at different time points.Results Compared with before extubation,24 h CRP,PCT and 72 h WBC,CRP and PCT of the two groups were decreased after extubation,and 72 h WBC,CRP and PCT of the HFNC group were significantly lower than those of the NPPV group,the difference was statistically significant(P<0.05).Compared with before extubation,the oxygenation index of both groups was significantly improved 72 hours after extubation,and PaCO_(2) was significantly decreased,with statistical significance(P<0.05).After extubation,RR and HR of both groups were lower at 72 h than before extubation,while RR at 72 h after extubation of HFNC group was lower th

关 键 词：慢性阻塞性肺疾病急性加重 经鼻高流量氧疗 肺部感染控制窗 炎症指标 

分 类 号：R459.6[医药卫生—治疗学]