HFNC与NIPPV对AECOPD合并Ⅱ型呼吸衰竭患者的临床疗效观察  

Clinical effect observation of HFNC and NIPPV on patients with AECOPD complicated with type Ⅱ respiratory failure

作　　者：应琴丽 周世彬 李焕根[2] 魏思灿[2] 黄鸣恋 陈伟文[2] Ying Qinli;Zhou Shibin;Li Huangen;Wei Sican;Huang Minglian;Chen Weiwen(Department of Clinical Medicine,Fujian Medical University,Fuzhou 350122,China)

机构地区：[1]福建医科大学临床医学部,福州350112 [2]福建医科大学附属泉州第一医院重症医学科

出　　处：《北京医学》2024年第3期204-209,共6页Beijing Medical Journal

基　　金：泉州市科技计划(2020C037R)。

摘　　要：目的探讨经鼻高流量氧疗(high-flow nasal cannula,HFNC)与无创正压通气(non-invasive positive pressure ventilation,NIPPV)对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭患者的临床疗效。方法选取2021年1月至2023年1月福建医科大学附属泉州第一医院重症医学科AECOPD患者146例,根据治疗方法不同分为NIPPV组(n=47)、HFNC组(n=49)和常规治疗组(n=50)。NIPPV组采用NIPPV治疗,HFNC组采用HFNC治疗,常规治疗组采用常规氧疗和抗感染治疗。比较3组循环指标、血气指标、呼吸支持时间、气道护理次数及舒适(general comfort questionnaire,GCQ)评分。结果146例患者中男76例、女70例,年龄56~77岁,平均(66.2±5.3)岁。与治疗前相比,治疗2 h和治疗24 h时,3组呼吸频率(respiratory rate,RR)和HR较低;治疗6 h和治疗24 h时,HFNC组RR、HR均低于NIPPV组和常规治疗组,差异有统计学意义(P<0.05)。与治疗前相比,治疗7 d后3组PaO_(2)均升高、PaCO_(2)均降低;治疗7 d后,与NIPPV组和常规组相比,HFNC组PaO_(2)较高、PaCO_(2)较低,差异有统计学意义(P<0.05)。3组呼吸支持时间和气道护理次数的差异有统计学意义(P<0.05),其中NIPPV组呼吸支持时间较短,HFNC组气道护理次数较少。结论HFNC可以改善AECOPD合并Ⅱ型呼衰患者的部分循环指标和血气指标,患者舒适度更好,但呼吸支持时间较长。Objective To explore the clinical effect of high-flow nasal cannula(HFNC)and non-invasive positive pressure ventilation(NIPPV)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with typeⅡrespiratory failure.Methods A total of 146 patients with AECOPD admitted in the Department of Critical Care Medicine of Quanzhou First Hospital,Fujian Medical University from January 2021 to January 2023 were selected and were divided into NIPPV group(n=47),HFNC group(n=49)and conventional group(n=50).The NIPPV group was treated with NIPPV,the HFNC group was treated with HFNC,and the conventional treatment group was treated with conventional oxygen therapy and anti-infection therapy.The circulation indicators,blood gas analysis index,respiratory support time,airway nursing times and general comfort questionnaire(GCQ)score before and after treatment were compared among the three groups.Results Among the 146 patients,there were 76 males and 70 females,aged from56 to 77 years,with an average age of(66.2±5.3)years.The respiratory rate(RR)and HR of the three groups were lower at 2 h and 24 h after treatment compared with the pre-treatment results,and RR,HR in HFNC group were lower than those in NIPPV group and conventional group at 6 h and 24 h after treatment,and the differences were statistically significant(P<0.05).Compared with the results of pre-treatment,PaO_(2) was increased and PaCO_(2) was decreased in the three groups after seven days of treatment,PaO_(2) was higer and PaCO_(2) was lower in HFNC group compared with NIPPV group and conventional group after seven days of treatment,and the differences were statistically significant(P<0.05).The differences of respiratory support time and airway nursing times among the three groups were statistically significant (P < 0.05), among which the respiratory support time in NIPPV group was shorter and the airway nursing times in HFNC group were lesser. Conclusions HFNC can improve some circulatory indicators and blood gas analysis results of AECOPD pa

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

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