不同流速呼吸高流量湿化治疗对COPD伴Ⅱ型呼吸衰竭患者呼气末二氧化碳分压的影响

Effects of Different Flow Rate and High-flow Respiration Treatment on End-tidal Carbon Dioxide Partial Pressure in Patients with COPD and Type Ⅱ Respiratory Failure

目的探讨不同流速呼吸高流量湿化治疗(HFNC)对慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭患者呼气末二氧化碳分压(PetCO2)的影响。方法选取该院2017年1月—2018年12月收治的120例COPD伴Ⅱ型呼吸衰竭患者为研究对象,将入组患者按随机数表法分为3组,给予不同流速的HFNC治疗,分别为10 L/min组(A组)、20 L/min组(B组)、30 L/min组(C组),各40例。治疗24 h后,对比各组患者PetCO2、动脉血氧饱和度(SpO2)、呼吸频率及痰液粘稠度的变化情况,同时对比观察2组患者的住院天数。结果治疗24 h后,3组患者PetCO2水平及SpO2水平均明显改善,且C组患者PetCO2水平明显低于B组和A组患者[(38.14±2.64)mmHg vs(41.37±2.77)mmHg vs(42.82±3.77)mmHg](F=23.895,P<0.001)。治疗24 h后,3组患者痰液粘稠度及呼吸频率均明显改善,且C组患者痰液粘稠度评分明显低于B组和A组患者[(0.93±0.27)分vs(1.27±0.34)分vs(1.41±0.33)分](F=24.817,P<0.05)。C组住院时间分别短于B组和A组患者[(9.98±2.26)d vs(11.62±2.67)d vs(13.70±3.28)d],差异有统计学意义(F=18.138,P<0.001)。结论高氧流量(30 L/min)的HFNC治疗COPD伴Ⅱ型呼吸衰竭可有效改善患者呼吸功能及临床症状。

Objective To investigate the effects of different flow rate respiratory high-flow humidification therapy(HFNC)on end-tidal carbon dioxide partial pressure(PetCO2)in patients with chronic obstructive pulmonary disease(COPD)and type II respiratory failure.Methods 120 patients with COPD and type II respiratory failure admitted to the hospital from January 2017 to December 2018 were enrolled.The patients were divided into 3 groups according to the random number table.The patients were given different rates of HFNC:10 L/min group(group A),20 L/min group(group B),and 30 L/min group(group C),40 cases each.After 24 hours of treatment,the changes of PetCO2,arterial oxygen saturation(SpO2),respiratory rate and sputum viscosity were compared between the groups,and the hospitalization days of the two groups were compared.Results After treatment for 24 hours,the levels of PetCO2 and SpO2 in the three groups were significantly improved,and the level of PetCO2 in group C was significantly lower than that in group B and group A[(38.14±2.64)mmHg vs(41.37±2.77)mmHg vs(42.82±3.77)mmHg](F=23.895,P<0.001).After 24 hours of treatment,the sputum viscosity and respiratory rate of the three groups were significantly improved,and the sputum viscosity score of group C was significantly lower than that of group B and group A[(0.93±0.27)points vs(1.27±0.34)points vs(1.41±0.33)points(F=24.817,P<0.05)].The hospital stay in group C was shorter than that in group B and group A[(9.98±2.26)d vs(11.62±2.67)d vs(13.70±3.28)d],the difference was statistically significant(F=18.138,P<0.001).Conclusion High-oxygen flow rate(30L/min)of HFNC in the treatment of COPD with type II respiratory failure can effectively improve respiratory function and clinical symptoms.