经鼻高流量氧疗在老年慢性阻塞性肺疾病急性加重期伴Ⅱ型呼吸衰竭患者中的应用  

Application of high flow nasal cannula oxygen therapy in elderly patients with acute exacerbation of chronic obstructive pulmonary disease and typeⅡrespiratory failure

作　　者：王晶[1] 唐娜[1] WANG Jing;TANG Na(Department of Emergency,XuanWu Hospital Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院急诊科,北京100053

出　　处：《中国临床研究》2024年第2期242-245,共4页Chinese Journal of Clinical Research

基　　金：国家重点研发计划课题(2020YFC2005402)。

摘　　要：目的研究经鼻高流量氧疗(HFNC)对老年慢性阻塞性肺疾病急性加重期(AECOPD)伴Ⅱ型呼吸衰竭患者的治疗效果。方法选择2022年1月至12月首都医科大学宣武医院急诊科收治的96例老年AECOPD伴Ⅱ型呼吸衰竭患者,随机分为观察组49例和对照组47例。对照组在常规抗炎、平喘治疗的基础上给予无创正压通气(NPPV)治疗,观察组患者常规抗炎、平喘治疗基础上给予HFNC治疗。比较两组患者治疗前后的pH值、动脉氧分压(PaO_(2))和动脉二氧化碳分压(PaCO_(2))的水平。应用调查问卷评估两组患者治疗舒适度。随访28 d,比较两组患者治疗后误吸、胃胀气等并发症发生率、气管插管率及病死率。结果两组治疗后pH值和PaO_(2)较前升高,PaCO_(2)较前降低(P<0.05),但两组间pH值、PaO_(2)和PaCO_(2)比较差异无统计学意义(P>0.05)。调查问卷显示观察组舒适度评分高于对照组(3.57±0.71 vs 2.46±0.83,t=7.020,P<0.01),并发症发生率低于对照组(10.20%vs 27.65%,χ^(2)=4.798,P<0.05),两组患者气管插管率和病死率差异无统计学意义(P>0.05)。结论HFNC同NPPV在老年AECOPD伴Ⅱ型呼吸衰竭患者中具有相近的治疗效果,但HFNC并发症较少,舒适程度高。Objective To investigate the therapeutic effect of high flow nasal cannula oxygen therapy(HFNC)on elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and typeⅡrespiratory failure.Methods A total of 96 elderly AECOPD patients with type 2 respiratory failure who received treatment at Xuanwu Hospital Capital Medical University from January to December 2022 were selected and divided into observation group(n=49)and control group(n=47)randomly.On the basis of conventional anti-inflammatory and antiasthmatic treatment,control group was treated with non-invasive positive pressure ventilation(NPPV),observation group was treated with HFNC.The level of pH value,arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))before and after treatment were compared between two groups.The treatment comfort was evaluated with questionnaires.After 28 days of follow-up,the incidence of complications such as aspiration,bloating,tracheal intubation rate and mortality rate were compared between two groups.Results After treatment,pH value and PaO_(2) increased,and PaCO_(2) decreased in both group(P<0.05).However,there was no significant difference in pH,PaO_(2) and PaCO_(2) between two groups after treatment(P>0.05).The score of comfort degree of the observation group was higher than that of the control group(3.57±0.71 vs 2.46±0.83,t=7.020,P<0.01),and the complication rate was lower than that of the control group(10.20%vs 27.65%,χ^(2)=4.798,P<0.05).There was no significant difference between the two groups in the tracheal intubation rate and mortality rate(P>0.05).Conclusion NPPV and HFNC have similar therapeutic effect in elderly AECOPD patients with type 2 respiratory failure,but HFNC has fewer complications and higher degree of comfort.

关 键 词：慢性阻塞性肺疾病 急性加重期 Ⅱ型呼吸衰竭 经鼻高流量氧疗 无创正压通气 气管插管 

分 类 号：R563.9[医药卫生—呼吸系统]