经鼻高流量氧气湿化治疗老年慢性阻塞性肺疾病急性加重合并呼吸衰竭的可行性研究  

Feasibility of heated humidified high flow nasal cannula oxygen therapy for acute exacerbation of chronic obstructive pulmonary disease with respiratory failure in elderly patients

作　　者：陈名珍[1] 杨珺楠[1] 李开来[1] 赵旭静[1] 薛安静 满姗姗 向平超[2] Chen Mingzhen;Yang Junnan;Li Kailai;Zhao Xujing;Xue Anjing;Man Shanshan;Xiang Pingchao(Department of Cadre's Ward,Peking University Shougang Hospital,Beijing 100144,China;Department of Respiratory&Critical Care Medicine,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学首钢医院干部保健科,北京100144 [2]北京大学首钢医院呼吸与危重症医学科,北京100144

出　　处：《中华临床医师杂志（电子版）》2022年第6期481-486,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：北京大学首钢医院科研与发展基金资助课题(SGYYZ201612)。

摘　　要：目的探讨经鼻高流量氧气湿化治疗(HFNC)老年慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭的可行性。方法选择2016年12月至2022年1月在北京大学首钢医院住院的老年AECOPD合并呼吸衰竭患者176例,HFNC组82例,无创正压通气(NPPV)组94例。比较2组患者治疗后脉搏氧饱和度(SPO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(OI)、呼吸频率(RR)、心率(HR)、平均动脉压(MAP)、舒适度评分、出院率、气管插管率、转重症监护室(ICU)率及死亡率。计量资料以x^(ˉ)±s表示,2组间比较采用独立样本t检验;计数资料以例数或百分比表示,采用χ^(2)检验。结果HFNC组治疗30 min SPO_(2)、1 h SPO_(2)、6 h SPO_(2)均显著高于NPPV组(t=-2.049、-2.618、-3.314,P=0.043、0.010、0.001);出院前SPO_(2)显著低于NPPV组(t=2.162,P=0.033),但各时间点及出院前OI差异无统计学意义(P>0.05)。治疗6 h MAPHFNC组显著高于NPPV组(t=-2.209,P=0.029),但均在正常范围;治疗2天及3天HR HFNC组显著高于NPPV组(t=-2.199、-2.336,P=0.030、0.021);其余各时间点及出院前2组RR、HR、MAP均差异无统计学意义(P>0.05)。2组中PaCO_(2)差异无统计学意义(P>0.05)。HFNC组舒适度评分显著高于NPPV组(t=-46.807,P<0.001)。2组患者出院率、转ICU率、气管插管率及死亡率比较差异均无统计学意义(P>0.05)。结论HFNC治疗老年AECOPD合并Ⅰ型或轻度Ⅱ型呼吸衰竭患者疗效与NPPV相当,HFNC较NPPV舒适度更高。Objective To investigate the feasibility of transnasal heated humidified high flow nasal cannula oxygen therapy(HFNC)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure in elderly patients.Methods A total of 176 elderly patients with AECOPD complicated with respiratory failure who were hospitalized at Peking University Shougang Hospital from December 2016 to January 2022 were enrolled,including 82 patients in an HFNC group and 94 patients in an NPPV group.After treatment,pulse oxygen saturation(SPO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(OI),respiratory rate(RR),heart rate(HR),mean arterial pressure(MAP),comfort score,discharge rate,rate of endotracheal intubation,rate of transfer to intensive care unit(ICU),and mortality were compared between the two groups.The independent sample t-test was used for comparison between the two groups.Statistical data are expressed in percentage or number of cases and theχ^(2) test was used for their comparisons.Results The SPO_(2) values at 30 min,1 h,and 6 h were significantly higher in the HFNC group than in the NPPV group(t=-2.049,-2.618,and-3.314,P=0.043,0.010,and 0.001,respectively).SPO_(2) before discharge was significantly lower than that of the NPPV group(t=2.162,P=0.033),but OI at each time point and before discharge had no statistical significance(P>0.05).MAP at 6 h was significantly higher in the HFNC group than in the NPPV group(t=-2.209,P=0.029),but within the normal range.HRs at 2 h and 3 h in the HFNC group were significantly higher than those of the NPPV group(t=-2.199 and-2.336,P=0.030 and 0.021,respectively).There were no significant differences in RR,HR,or MAP between the two groups at other time points and before discharge(P>0.05).There was no significant difference in PaCO_(2) between the two groups(P>0.05).Comfort score in the HFNC group was significantly higher than that of the NPPV group(t=-46.807,P<0.001).There were no significant differences in discharge rat

关 键 词：经鼻高流量氧气湿化治疗 老年患者 慢性阻塞性肺疾病急性加重合并呼吸衰竭 无创正压通气 治疗 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]