经鼻高流量氧疗在慢性阻塞性肺疾病急性加重患者有创呼吸机序贯治疗中的临床效果
Clinical efficacy of transnasal hyperbaric oxygen therapy in sequential invasive ventilator therapy for patients with acute exacerbation of chronic obstructive pulmonary disease

陈俊.经鼻高流量氧疗在慢性阻塞性肺疾病急性加重患者有创呼吸机序贯治疗中的临床效果[J].内科急危重症杂志,2019,25(5):394-396

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DOI：10.11768/nkjwzzzz20190512

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作者	单位	E-mail
陈俊	青海省交通医院	360918457@qq.com

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中文摘要:

目的：探讨经鼻高流量（HFNC）氧疗在慢性阻塞性肺疾病急性加重（AECOPD）患者有创呼吸机序贯治疗中的效果。方法：筛选患AECOPD需气管插管行有创呼吸机治疗的患者35例，经治疗患者病情改善出现“肺部感染控制窗”后，将患者随机分为有创 HFNC序贯组18例和有创无创序贯组(NIV)17例。观察患者48h内再插管率、ICU住院时间以及不良事件发生率。结果：48h内HFNC组3例(16.7%)患者需要再插管,NIV组2例（11.8%）患者再插管（P>0.05），HFNC组ICU住院时间明显短于NIV组\[(10.4±1.8)d vs (14.2±1.1)d，P=0.023\]，不良事件HFNC组发生1例(5.6%) ，NIV组5例（29.4%），2组比较有明显统计学差异（P<0.01）。结论：以“肺部感染控制窗”为切换点实施有创呼吸机经鼻高流量序贯通气策略与无创序贯通气治疗效果相似，且可缩短ICU住院时间，显著减少无创通气的不良事件发生率。

英文摘要:

Objective: To explore the efficacy of transnasal hyperflow (HFNC) oxygen therapy in invasive ventilator sequential therapy for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: Thirty-five patients with AECOPD given tracheal intubation and invasive ventilator therapy were included in the study. After the improvement of the patients' conditions and the "pulmonary infection control window", the patients were randomly divided into the invasive-HFNC sequential therapy group (HFNC, 18 cases) and the invasive-no-invasive sequential therapy group (NIV, 17 cases). The primary endpoint was the reintubation rate within 48h, and the secondary endpoint was the length of ICU hospital stay and the incidence of adverse events. Results: Three patients (16.7%) in the HFNC group (16.7%) and two patients (11.8%) in the NIV group (P>0.05) were reintubated within 48h. ICU hospital stay in the HFNC group was significantly shortened as compared with that in the NIV group \[(10.4±1.8)days vs (14.2±1.1) days, P=0.023\]. Conclusion: The results of invasive ventilator-transnasal high-flow sequential ventilation strategy with "pulmonary infection control window" as the switching point are similar to those of non-invasive sequential ventilation, which can shorten the ICU hospitalization time and significantly reduce the adverse events of non-invasive ventilation.