高流量氧疗与无创正压通气治疗COPD伴呼吸衰竭的比较

Comparison of hyperflow oxygen therapy and NPPV in treatment of COPD complicated with respiratory failure

目的比较经鼻高流量氧疗(HFNC)与无创正压通气(NPPV)治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效及安全性。方法将93例COPD伴Ⅱ型呼衰的患者随机分为NPPV组(46例)与HFNC组(47例)。两组均给予支气管扩张剂、抗感染、祛痰止咳等常规治疗,此外,NPPV组给予NPPV治疗,HFNC组给予HFNC治疗。比较两组治疗前后呼吸频率、心率、血气分析变化以及治疗24 h后的舒适度、治疗期间不良反应的发生率。结果 HFNC组的舒适度显著优于NPPV组;两组治疗均能有效减缓患者呼吸频率、心率,纠正低氧血症和高碳酸血症状态,但HFNC组治疗24、48 h后的心率、呼吸频率、p H值及PaCO2均显著低于NPPV组,PaO2明显高于NPPV组(P <0.05)。HFNC组并发症发生率较NPPV组明显减少(P <0.05)。结论对于COPD合并Ⅱ型呼吸衰竭,HFNC治疗较NPPV舒适度高,患者更易耐受,纠正低氧血症和高碳酸血症的效果也较NPPV显著,且不良反应发生率低。

Objective To compare the clinical effects and safety of transnasal hyperflow oxygen therapy(HFNC)and noninvasive positive pressure ventilation(NPPV)in the treatment of chronic obstructive pulmonary disease(COPD)complicated with type-2 respiratory failure.MeAods A total of 93 patients with COPD complicated with type-2 respiratory^failure were randomly divided into a NPPV group(n=46)and a HFNC group(n=47).The two groups were treated with bronchodilators,anti-infection,expelling phlegm to arrest coughing and other conventional therapy.On the basis of this,the NPPV group was additionally treated with NPPV and the HFNC group with HFNC.The changes in the respiratory rate,heart rate(HR)and blood gas analysis before and after the treatment,comfort level after 24 hours of treatment and the incidence of adverse reactions during treatment were compared between the two groups.R伪ults The comfort level in the HFNC group was significantly higher than that in the NPPV group;the treatment in the two groups can effectively slow patients'respiratory rate and HR and correct hypoxemia and hypercapnia.However,the HR,respiratory rate,pH and PaC〇2 after 24 and 48 hours of treatment were significantly lower than those in the NPPV group,and PaO2 was significantly higher than that in the NPPV group(P<0.05).The incidence of complications in the HFNC group was significantly lower than that in the NPPV group(P<0.05).Conclusion HFNC can ensure higher comfort level than NPPV in the treatment of COPD complicated with type-2 respiratory failure.Patients are more tolerant of HFNC.In addition,HFNC have more significant effects in the correction of hypoxemia and hypercapnia,and the incidence of adverse reactions is lower.