加湿高流量鼻导管吸氧对慢性阻塞性肺疾病伴慢性低氧血症的影响  

Effect of humidified high-flow nasal cannula on pulmonary function,activity and risk of AECOPD in patients with COPD and chronic hypoxemia

作　　者：雷露 LEI Lu(Lishui People’s Hospital,Lishui323000,China)

机构地区：[1]丽水市人民医院,浙江丽水323000

出　　处：《浙江实用医学》2024年第4期271-276,285,共7页Zhejiang Practical Medicine

摘　　要：目的探讨加湿高流量鼻导管吸氧(humidified high-flow nasal cannula,HFNC)对慢性阻塞性肺疾病(COPD)伴慢性低氧血症肺功能、日常活动能力及AECOPD风险的影响。方法纳入2021年2月~2022年8月在浙江省丽水市人民医院就诊的COPD伴低氧血症需长期氧疗患者188例,按照随机数字表法分为HFNC组和对照组,每组94例。HFNC组接受加湿高流量鼻导管吸氧(氧流量:15~20L/min),对照组接受常规低流量吸氧(氧流量:1~3L/min);随访1年,分别于氧疗开始后1、3、9、12个月测量患者肺功能指标,采用圣乔治呼吸问卷(SGRQ)对患者生活质量进行评分,采用改良医学研究委员会呼吸困难评分(mMRC)对患者呼吸困难程度进行评分,采用6分钟步行试验(6MWT)对患者活动能力进行评价;记录两组研究前及研究后1年因AECOPD住院次数。结果(1)肺功能指标。从研究第3个月开始,HFNC组在用力肺活量(Forced vital capacity,FVC)、第一秒用力呼气容积(forced expiratory volume in one second,FEV1)、FEV1/FVC指标均优于对照组(P<0.05);在随访9个月、12个月时,HFNC组PaO_(2)、PaCO_(2)比对照组更低(P<0.05)。(2)生活能力。从第3个月开始HFNC组mMRC评分低于对照组(P<0.05);在第9、12个月时,HFNC组SGRQ评分、6MWT及PaCO_(2)优于对照组(P<0.05)。(3)AECOPD风险。研究前两组患者因AECOPD住院次数比较差异无统计学意义(P>0.05);随访1年内,HFNC组住院次数低于对照组(P<0.05);同时HFNC组发生AECOPD的风险低于对照组(χ^(2)=14.412,P<0.05)。结论加湿高流量鼻导管吸氧能够明显改善需长期氧疗患者的肺功能,提高生活质量,降低发生AECOPD的风险。Objective To investigate the effects of humidified high-flow nasal cannula(HFNC)on lung function,daily activity and risk of AECOPD in patients with chronic hypoxemia.Method A total of 188 patients with long-term oxygen therapy who underwent COPD with hypoxemia from February 2021 to August 2022 were enrolled in the hospital.According to the random number table,they were divided into HFNC group and control group,94 cases each;HFNC group Receiving humidification and high-flow nasal catheter oxygen(oxygen flow:15~20L/min),the control group received conventional low-flow oxygen(oxygen flow:1~3L/min);After 1 year of follow-up,the lung function indexes of the patients were measured at 1,3,9 and 12 months after the start of therapy.The quality of life of the patients was scored by St George’s Respiratory Questionnaire(SGRQ).The Difficult Score(modified MRC)scored the patient’s dyspnea,and the 6-min walk test(6MWT)was used to evaluate the patient’s mobility;the two groups were recorded for acute exacerbation of COPD 1 year before and 1 year after study(AECOPD)Number of hospitalizations.Result(1)Pulmonary function index:Forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC in the HFNC group from the third month of the study and the FVC index was superior to the control group,and the difference was statistically significant(P<0.05);At 9 months and 12 months of follow-up,the difference of PaO_(2) and PaCO_(2) in HFNC group was statistically significant(P<0.05).(2)Living ability:The mMRC score was lower in the HFNC group than in the control group in the third month(P<0.05);at the 9th and 12th months,the SGRQ score,6MWT and PaCO_(2) in the HFNC group were superior to the control group(P<0.05);(3)AECOPD risk:There was no significant difference in the number of AECOPD hospitalizations between the two groups in the first year of the study(P>0.05).The number of hospitalizations in the HFNC group was lower than the control group(P<0.05);at the same time,the risk of AECOPD in the HFNC group was lower

关 键 词：慢性阻塞性肺疾病 高流量吸氧 鼻导管 生活质量 COPD急性加重期 

分 类 号：R563.9[医药卫生—呼吸系统]