经鼻高流量湿化氧疗治疗AECOPD合并Ⅱ型呼吸衰竭的疗效分析

Curative effect of humidified high-flow nasal cannula oxygen therapy on AECOPD with typeⅡrespiratory failure

目的研究经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的疗效。方法回顾性分析四川大学华西医院2017年10月至2020年2月诊治的60例AECOPD合并Ⅱ型呼吸衰竭患者病例作为研究对象,采用非随机临床同期对照研究及患者自愿原则法分为氧疗组28例和对照组32例,其中对照组接受无创正压通气治疗,氧疗组接受经鼻高流量湿化氧疗治疗。比较两组患者治疗前后的血气分析、炎症因子以及生命指标水平,并比较临床疗效和舒适度情况。结果治疗后,两组患者治疗有效率无显著差异(P>0.05);治疗后两组患者pH无显著差异(P>0.05),血氧饱和度(SpO_(2))、动脉氧分压(PaO_(2))均较治疗前明显提升,二氧化碳分压(PaCO_(2))较治疗前明显下降,氧疗组提升或下降水平高于对照组(P<0.05);治疗后两组患者心率(HR)、呼吸频率(RR)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、中性粒细胞/淋巴细胞(NLR)、降钙素原(PCT)较治疗前明显下降,氧疗组患者的下降水平高于对照组(P<0.05);治疗后氧疗组舒适度评分高于对照组,呼吸窘迫评分低于对照组(P<0.05)。结论经鼻高流量湿化氧疗应用于AECOPD合并Ⅱ型呼吸衰竭治疗中,可有效改善其血气分析指标,降低RR和HR,减轻炎症反应,提高患者使用舒适度,整体疗效较好,具有一定的临床应用价值。

Objective This study was aimed to study the curative effect of humidified high-flow nasal cannula oxygen therapy on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with typeⅡrespiratory failure.Methods Between October 2017 and February 2020,60 patients with AECOPD and typeⅡrespiratory failure diagnosed and treated in the hospital were enrolled in this study.They were divided into oxygen therapy group 28 cases and control group 32 cases based on the non-randomized clinical concurrent controlled trail and the patient voluntary principle.The control group received non-invasive positive pressure ventilation,while the oxygen therapy group received humidified high-flow nasal cannula oxygen therapy.The two groups were compared in terms of blood gas analysis,inflammatory factors,and vital signs before and after treatment,clinical effects,and comfort.Results After treatment,no significant differences were found in response rate and pH value between the two groups(P>0.05).Blood oxygen saturation(SpO_(2))and arterial partial pressure of oxygen(PaO_(2))significantly increased,while the partial pressure of carbon dioxide(PaCO_(2))significantly decreased.Besides,changes were greater in the oxygen therapy group than in the control group(P<0.05).After treatment,heart rate(HR),respiratory rate(RR),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),the neutrophil to lymphocyte ratio(NLR),and procalcitonin(PCT)decreased significantly,and decreases were greater in the oxygen therapy group than in the control group(P<0.05).After treatment,the oxygen therapy group had higher comfort scores and lower respiratory distress scores than the control group(P<0.05).Conclusion The above results suggest that applying humidified high-flow nasal cannula oxygen therapy in the treatment of AECOPD with typeⅡrespiratory failure can effectively improve blood gas indexes,reduce RR and HR,relieve inflammatory response,and improve patient comfort,with good overall effect.