有创ETI-MV后HFNC与NIPPV治疗老年COPD合并呼吸衰竭的临床效果分析  

Analysis on clinical effect of HFNC and NIPPV after invasive ETI-MV in treating senile chronic obstructive pulmonary disease complicating respiratory failure

作　　者：胡佚凡[1] 高锦 李娜[1] 阎京京[1] 王婷[1] 刘春红[1] 韩彩霞 杨侠[1] HU Yifan;GAO Jin;LI Na;YAN Jingjing;WANG Ting;LIU Chunhong;HAN Caixia;YANG Xia(Department of Respiratory and Critical Care Medicine,Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an,Shaanxi 710004,China)

机构地区：[1]西安交通大学第二附属医院呼吸与危重症医学科,710004

出　　处：《重庆医学》2022年第11期1908-1911,1916,共5页Chongqing medicine

基　　金：2021年陕西省重点研发计划一般项目(2021SF-039)。

摘　　要：目的探讨老年慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者有创气管插管机械通气(ETI-MV)后应用经鼻高流量氧疗(HFNC)与无创正压通气(NIPPV)治疗的临床效果。方法选取该院2019年12月至2021年3月收治的COPD急性加重期(AECOPD)合并急性呼吸衰竭(ARF)的老年患者60例,采用简单化数字随机法将患者分为观察组和对照组,每组各30例,两组患者均以ETI-MV为起始呼吸支持方式,拔管后观察组给予HFNC呼吸支持,对照组给予NIPPV呼吸支持,观察比较两组患者生命体征、血气分析及临床结局情况。结果观察组患者在拔管后2、24 h呼吸频率高于对照组,拔管后24、72 h动脉血氧分压(PaO_(2))水平低于对照组,拔管后7 d动脉血二氧化碳分压(PaCO_(2))水平高于对照组,两组患者上述指标比较,差异均有统计学意义(P<0.05)。观察组患者7 d再插管率高于对照组(33.33%vs.6.67%,P<0.05),不耐受率低于对照组(6.67%vs.43.33%,P<0.05),鼻面部皮损及腹胀气等并发症总发生率低于对照组(0 vs.26.67%,P<0.05)。结论HFNC有较高的适用性和舒适度,适用于不耐受和口鼻皮肤不宜应用者;但NIPPV在AECOPD合并ARF老年患者中的应用效果更具优势。Objective To investigate the clinical effect of high-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)after invasive endotracheal intubation mechanical ventilation(ETI-MV)in senile chronic obstructive pulmonary(COPD)complicating respiratory failure.Methods Sixty elderly patients with COPD complicating acute respiratory failure(ARF)in this hospital from December 2019 to March 2021 were selected and randomly divided into the observation group and control group according to the simplified digital method,30 cases in each group.Both groups used ETI-MV as the initial respiratory support method.The observation group was given the HFNC support after extubation.The control group was given the NIPPV respiratory support.The differences in vital signs,blood gas analysis and clinical outcome were observed and compared between the two groups.Results The respiratory rate at 2,24 h after extubation in the observation group was higher than that in the control group(P<0.05).The PaO_(2) level at 24,72 h after extubation in the observation group was lower than that in the control group(P<0.05).The PaCO_(2) level on 7 d after extubation in the observation group was higher than that in the control group,and the comparison of above indicators between the two groups showed statistical difference(P<0.05).The rate of re-intubation in the observation group was higher than that in the control group(33.33%vs.6.67%,P<0.05),the intolerance rate was lower than that in the control group(6.67%vs.43.33%,P<0.05).The total incidence rate of nasal and facial skin lesions and abdominal distension was lower than that in the control group(0 vs.26.67%,P<0.05).Conclusion HFNC has higher applicability and comfort level,is suitable for the patients with intolerance and oral and nasal skin inadvisable.But the application effect of NIPPV in the elderly patients with AECOPD complicating ARE has more advantages.

关 键 词：慢性阻塞性肺疾病 急性呼吸衰竭 气管插管机械通气 无创正压通气 高流量氧疗 

分 类 号：R459.6[医药卫生—治疗学]