黄斌.经鼻高流量湿化氧疗在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者中的临床疗效[J].内科急危重症杂志,2023,29(5):381-385
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| DOI：10.11768/nkjwzzzz20230506 |
| 中文关键词: 慢性阻塞性肺疾病 急性加重期 呼吸衰竭 经鼻高流量湿化氧疗 无创正压通气 |
| 英文关键词: |
| 基金项目:国家自然科学基金（No:82160002；82160014）；桂林市科学研究与技术开发计划项目（No:20190218 7 8） |
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| 中文摘要: |
| 摘要 目的：探讨经鼻高流量湿化氧疗（HFNC）在慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者中的临床疗效。方法：将90例AECOPD合并Ⅱ型呼吸衰竭患者随机分为对照组和观察组，每组45例。在抗感染、解痉平喘、祛痰、营养支持等常规治疗基础上，对照组给予无创正压通气（NPPV）、观察组予以HFNC治疗，疗程均为7d。比较2组患者治疗前、治疗1d及7d后动脉血气分析指标（PaO2、PaCO2）、氢离子浓度指数（pH）、平均动脉压（MAP）、心率、呼吸频率、C反应蛋白（CRP）、白细胞介素6（IL-6）、肿瘤坏死因子-α（TNF-α）、生存质量 [圣•乔治医院呼吸疾病调查问卷（SGRQ）评分]、舒适状况量表（GCQ）评分、住院时间及不良反应。结果：治疗1d、7d后，2组PaO2、pH值及GCQ评分较治疗前升高，且治疗7d后高于治疗1d后，观察组GCQ评分高于对照组（P均<0.05）；PaCO2、MAP、心率、呼吸频率及SGRQ评分较治疗前降低，且治疗7d后低于治疗1d后，观察组SGRQ评分低于对照组（P均<0.05）。治疗7d后，观察组心率及呼吸频率低于对照组，2组CRP、IL-6、TNF-α水平较治疗前降低，且观察组低于对照组（P均<0.05）。观察组平均住院时间短于对照组，不耐受、面部压伤、鼻腔出血及胃肠胀气发生率低于对照组（P均<0.05）。结论：HFNC与NPPV均是AECOPD合并Ⅱ型呼吸衰竭呼吸支持治疗的有效方式，但HFNC在改善临床症状、缓解炎性反应及舒适耐受性方面更具优势，可显著提高生存质量，降低不良反应发生率。 |
| 英文摘要: |
| Abstract Objective: To investigate the clinical efficacy of high-flow nasal canula oxygen therapy (HFNC) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type II respiratory failure. Methods: A total of 90 AECOPD patients with type II respiratory failure were randomly divided into control group and observation group, with 45 cases in each group. On the basis of conventional treatments such as anti-infection, antispasmodic and asthma relief, expectoration and nutritional support, the control group was given non-invasive positive-pressure ventilation (NPPV), and the observation group was given HFNC, and the course of treatment was 7days. Arterial blood gas analysis indexes (PaO2, PaCO2), hydrogen ion concentration index (pH), mean arterial pressure (MAP), heart rate, respiratory rate, C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were compared between the two groups before treatment, 1 day after treatment and 7 days after treatment. Quality of life \[St. George's Hospital Respiratory Disease Questionnaire (SGRQ) score\], general comfort questionnaire (GCQ) score, length of hospital stay and adverse events were analyzed. Results: After 1d and 7d of treatment, PaO2, pH and GCQ scores in the 2 groups were higher than those before treatment, those were higher after 7d than after 1d of treatment, and GCQ scores in the observation group were higher than those in the control group (all P<0.05). PaCO2, MAP, heart rate, respiratory rate and SGRQ scores after treatment were lower than those before treatment, and those were lower after 7d than after 1d of treatment, and SGRQ scores in the observation group were lower than those in the control group (all P<0.05). After 7d of treatment, the heart rate and respiratory rate in the observation group were lower than those in the control group, and the levels of CRP, IL-6, and TNF-α in the 2 groups were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). The average hospitalization time in the observation group was shorter than that in the control group, and the incidence of intolerance, facial compression, nasal hemorrhage and gastrointestinal flatulence in the observation group was lower than those in the control group (all P<0.05).Conclusion: HFNC and NPPV are both effective modalities of respiratory support therapy for AECOPD complicated with type II respiratory failure, but HFNC is more advantageous in improving clinical symptoms, relieving inflammatory response and comfort tolerance, which can significantly improve the quality of life and reduce the incidence of adverse reactions. |
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