经鼻高流量湿化治疗仪治疗慢阻肺急性加重期伴呼吸性酸中毒患者的效果

Effect of High-flow Nasal Cannula Oxygen Therapy on Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Respiratory Acidosis

目的:分析经鼻高流量湿化治疗仪应用于慢阻肺急性加重期伴呼吸性酸中毒的治疗效果,探讨其对患者血气指标及肺功能的影响。方法:回顾性分析2022年1月—2023年10月在北京市昌平区医院呼吸与危重症学科治疗的100例慢阻肺急性加重伴呼吸性酸中毒患者的临床资料。根据治疗方式的不同分为两组,各50例。观察组接受经鼻高流量湿化氧疗,对照组接受无创正压通气治疗。比较两组的血气指标、肺功能指标、治疗效果及不良反应发生情况。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组血气指标、肺功能指标比较,差异无统计学意义(P>0.05);治疗后,两组pH值、氧分压(PaO_(2))、氧合指数(OI)均高于治疗前,二氧化碳分压(PaCO_(2))低于治疗前,且观察组pH值、PaO_(2)、OI高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。治疗后,两组第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、呼气峰流速值(PEF)、第1秒用力呼气容积/用力肺活量(FEV_(1)/FVC%)均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:经鼻高流量湿化氧疗、无创正压通气治疗都是慢阻肺急性加重期伴呼吸性酸中毒辅助通气的有效方法,而经鼻高流量湿化氧疗可有效提高治疗效果,改善患者血气指标及肺功能,不良反应少,安全性更高。

Objective:To analyze the effect of high-flow nasal cannula oxygen therapy instrument on acute exacerbation of chronic obstructive pulmonary disease with respiratory acidosis,and to explore its influence on blood gas index and lung function.Method:The clinical data of 100 patients with acute exacerbation of chronic obstructive pulmonary disease with respiratory acidosis treated in the Department of Respiratory and Critical Care in Beijing Changping Hospital from January 2022 to October 2023 were retrospectively analyzed.They were divided into two groups according to different treatment methods,with 50 cases in each group.The observation group received high-flow nasal cannula oxygen therapy,and the control group received non-invasive positive pressure ventilation.Blood gas index,lung function index,therapeutic effect and occurrence of adverse reactions between the two groups were compared.Result:The total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).Before treatment,there were no significant differences in blood gas index and lung function index between the two groups(P>0.05).After treatment,pH value,oxygen partial pressure(PaO_(2))and oxygenation index(OI)of the two groups were higher than those before treatment,and partial pressure of carbon dioxide(PaCO_(2))was lower than that before treatment,and pH value,PaO_(2) and OI of the observation group were higher than those of the control group,and PaCO_(2) was lower than that of the control group,the differences were statistically significant(P<0.05).After treatment,the first second forced expiratory volume(FEV_(1)),forced vital capacity(FVC),peak expiratory flow rate(PEF),and the first second forced expiratory volume/forced vital capacity(FEV_(1)/FVC%)in both groups were higher than those before treatment,and which in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:High-flow nasal cannula oxygen therapy and non-invasive positive pressure ventilation are both effective methods for assisted ventilation of patients with acute exacerbation of chronic obstructive pulmonary disease with respiratory acidosis,and high-flow nasal cannula oxygen therapy can effectively improve the therapeutic effect,improve the blood gas index and lung function of patients,with fewer adverse reactions and higher safety.