经鼻高流量湿化氧疗在C O PD合并2型呼吸衰竭患者气管插管拔管后的应用价值分析

Analysis of the Application Value of High-flow Humidified Oxygen Therapy through the Nose in COPD Patients with Type 2 Respiratory Failure after Tracheal Intubation and Extubation

目的探讨经鼻高流量湿化氧疗(HHFNC)在COPD合并2型呼吸衰竭患者气管插管拔管后的应用价值。方法选取2017年9月—2019年9月期间在该院进行机械通气治疗并拔管的COPD合并2型呼吸衰竭的72例患者为研究对象,按照随机数表法将入组患者分为无创正压通气(NPPV)组、经鼻高流量湿化氧疗(HHFNC)组,各36例。NPPV组患者接受NPPV干预,HHFNC组患者接受HHFNC干预。对比两组患者持续干预24 h后血气指标、呼吸频率、心率、血压水平、再次插管、气管切开、ICU停留时间的差异。结果治疗后,HHFNC组患者的pH(7.35±0.10)、PaO2(68.27±9.11)mmHg、PaO2/FiO2水平(221.63±27.55)高于NPPV组(7.29±0.12)、(64.33±8.03)mmHg、(200.33±24.57),差异有统计学意义(t=3.922、4.955、5.282,P<0.05);HHFNC组患者的PaCO2(62.17±8.56)mmHg、呼吸频率(25.16±3.42)次/min、心率(85.12±9.50)次/min、平均动脉压(94.51±11.98)mmHg水平低于NPPV组(67.55±8.24)mmHg、(28.74±3.65)次/min、(93.45±10.83)次/min、(108.72±12.14)mmHg,差异有统计学意义(t=5.011、5.839、6.129、7.093,P<0.05);两组患者的再次插管率、气管切开率差异无统计学意义(χ^2=0.000、1.014,P>0.05);HHFNC组患者的ICU停留时间短于NPPV组患者,差异有统计学意义(P<0.05)。结论相较于NPPV,HHFNC用于COPD合并2型呼吸衰竭患者的治疗,可更为有效地优化患者的通气功能并加速康复。

Objective To explore the value of transnasal high-flow humidified oxygen therapy(HHFNC) in patients with COPD and type 2 respiratory failure after tracheal intubation and extubation. Methods From September 2017 to September 2019, 72 patients with COPD combined with type 2 respiratory failure who underwent mechanical ventilation and extubation in the hospital were selected as the research objects, and the patients were divided into non-invasive positive pressure according to the random number table method Ventilation(NPPV) group, transnasal high flow humidification oxygen therapy(HHFNC) group, 36 cases in each. Patients in the NPPV group received NPPV intervention, and patients in the HHFNC group received HHFNC intervention. The differences in blood gas indexes,respiratory rate, heart rate, blood pressure level, reintubation, tracheotomy, and ICU stay time between the two groups of patients after 24 h continuous intervention were compared. Results After treatment, the pH(7.35±0.10), PaO2(68.27±9.11) mmHg, PaO2/FiO2 level(221.63±27.55) of the HHFNC group were higher than those of the NPPV group(7.29±0.12),(64.33±8.03) mm Hg,(200.33±24.57), the difference was statistically significant(t=3.922, 4.955, 5.282, P<0.05);PaCO2(62.17±8.56) mmHg, respiratory rate(25.16±3.42) times/min, heart rate(85.12±9.50) times/min, mean arterial pressure(94.51±11.98) mmHg level is lower than NPPV group(67.55 ±8.24) mmHg,(28.74 ±3.65) times/min,(93.45 ±10.83) times/min,(108.72±12.14) mmHg, the difference was statistically significant(t=5.011, 5.839, 6.129, 7.093, P<0.05);there was no significant difference in the reintubation rate and tracheotomy rate between the two groups of patients(χ^2=0.000, 1.014, P>0.05);the ICU stay time of the HHFNC group was shorter than that of the NPPV group,the difference was statistically significant(P<0.05). Conclusion Compared with NPPV, HHFNC used in the treatment of COPD patients with type 2 respiratory failure can more effectively optimize the patient’s ventilation function and accelerate recovery.