经鼻高流量氧疗治疗慢性阻塞性肺疾病合并睡眠呼吸暂停综合征的效果分析  

High-flow nasal cannula therapy in patients with chronic obstructive pulmonary disease complicated with obstructive sleep apnea

作　　者：黄虎翔[1] 王昌锋[1] 吴登峰 Huang Huxiang;Wang Changfeng;Wu Dengfeng(Department of Respiratory and Critical Care Medicine,Huanggang Central Hospital affiliated to Yangtze University,Huanggang,438000,China)

机构地区：[1]长江大学附属黄冈市中心医院呼吸与危重症医学科,黄冈438000

出　　处：《国际呼吸杂志》2024年第4期427-431,共5页International Journal of Respiration

基　　金：湖北省青年医学拔尖人才(鄂卫通[2019]48号);黄冈市科技计划(XQYF2020000018)。

摘　　要：目的对比无创辅助通气(NIV)探讨经鼻高流量氧疗(HFNC)治疗慢性阻塞性肺疾病合并睡眠呼吸暂停重叠综合征(OCOS)的疗效。方法本研究为前瞻性、随机对照研究,因2组设备不同无法设盲。采用随机抽样的方法纳入2020年1月至2022年12月于黄冈市中心医院住院的OCOS伴呼吸衰竭且接受呼吸支持的169例患者,随机分配至HFNC组(85例)和NIV组(84例)。观察2组患者基础资料、呼吸频率、血气分析指标(pH值、PaO_(2)和PaCO_(2))、睡眠呼吸暂停指数(AHI)、夜间最低血氧饱和度(SaO_(2)LOW)、鼻面部损伤、胃肠胀气的比例、有创机械通气率、呼吸支持时间、住院时间和28 d病死率。结果HFNC组85例,男56例,女29例,年龄67(62,72)岁;NIV组84例,男57例,女27例,年龄68(60,76)岁。2组性别、年龄、OCOS年限、AHI、肺功能、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,炎性因子(CRP、PCT)和基础疾病差异均无统计学意义(均P>0.05)。2组的呼吸频率、PaCO_(2)和AHI均较治疗前降低,分别为:呼吸频率HFVC组(28.12±5.46)次/min比(21.92±4.89)次/min,NIV组(27.62±6.32)次/min比(21.73±4.84)次/min;PaCO_(2)HFVC组(66.83±6.96)mmHg比(45.27±7.63)mmHg,NIV组(67.90±7.01)mmHg比(44.55±7.37)mmHg;AHI HFVC组(16.47±3.56)次/h比(10.71±3.14)次/h,NIV组(17.35±4.55)次/h比(9.79±3.23)次/h差异有统计学意义(均P<0.05)。2组患者治疗72 h后pH值、PaO_(2)、SaO_(2)LOW均较治疗前升高,分别为pH值HFVC组(7.24±0.05)比(7.41±0.12),NIV组(7.25±0.06)比(7.41±0.10);PaO_(2)HFVC组(57.80±8.96)mmHg比(72.56±15.77)mmHg,NIV组(56.93±9.01)mmHg比(73.06±16.19)mmHg;SaO_(2)LOW HFVC组(86.41±5.17)比(93.13±3.31),NIV组(84.76±6.11)比(93.79±3.46),差异均有统计学意义(均P<0.05)。治疗后2组患者以上指标差异均无统计学意义(均P>0.05);HFNC组鼻面部损伤胃肠胀气少于NIV组(1.2%比19.0%,χ^(2)=14.91,P=0.001);2组患者有创机械通气率、呼吸支持时间、患者住院时间、28 dObjective To explore the efficacy of high-flow nasal cannula(HFNC)therapy in the treatment of chronic obstructive pulmonary disease(COPD)-obstructive sleep apnea(OSA)overlap syndrome(OCOS),compared with non-invasive assisted ventilation(NIV).Methods This was a prospective randomized control study.Blinding cannot be set due to the different equipments in the two groups.Random sampling method was used.A total of 169 patients with COPD-OSA overlap syndrome complicated with respiratory failure receiving assisted ventilation from January 2020 to December 2022 in Huanggang Central Hospital were enrolled in this study.These patients were divided into HFNC group(85 cases)and NIV group(84 cases)by random system sampling method.Respiratory rate,arterial blood gas(pH,PaO_(2),and PaCO_(2)),apnea hypopnea index(AHI),minimum blood oxygen saturation at night(SaO_(2)LOW),nasal and facial injuries,flatulence,invasive mechanical ventilation rate,duration of respiratory support,length of hospital stay,and 28d mortality were observed.Results There were 85 cases(56 male and 29 female)in HFNC group,with the age of 67(62,72)years;there were 84 cases(57 male and 27 female)in the NIV group,with the age of 68(60,76)years.There were no significant differences in gender,age,OCOS years,AHI,pulmonary function,APACHEⅡscore,inflammatory factors(CRP,PCT)and underlying diseases between the two groups(all P>0.05).The respiratory rate,PaCO_(2),and AHI in both groups decreased after treatment,with all differences statistically significant(all P<0.05).Respiratory rate in HFVC group was(28.12±5.46)breaths/min vs(21.92±4.89)breaths/min and in NIV group was(27.62±6.32)breaths/min vs(21.73±4.84)breaths/min.PaCO_(2)in HFVC group was(66.83±6.96)mmHg vs(45.27±7.63)mmHg,and in NIV group was(67.90±7.01)mmHg vs(44.55±7.37)mmHg.AHI in HFVC group was(16.47±3.56)times/h vs(10.71±3.14)times/h,and in NIV group was(17.35±4.55)times/h vs(9.79±3.23)times/h.PH,PaO_(2),and SaO_(2)LOW in both groups increased compared to those before treatment,with all diff

关 键 词：睡眠呼吸暂停综合征 肺疾病 慢性阻塞性 经鼻高流量氧疗 无创辅助通气 

分 类 号：R563.9[医药卫生—呼吸系统] R766[医药卫生—内科学]