经鼻高流量湿化氧疗在合并高碳酸血症慢性阻塞性肺疾病患者中的应用分析

Analysis on the application of nasal high-flow humidification oxygen therapy in COPD patients complicated with hypercapnia

目的探究经鼻高流量湿化氧疗对合并高碳酸血症的慢性阻塞性肺疾病(COPD)患者的疗效。方法选取2017年5月~2019年10月在本院接受治疗的30例COPD患者作为研究对象,将患者随机分为对照组和试验组,每组各15例,两组均予以常规药物治疗,对照组患者在此基础上采用无创通气,试验组患者采用经鼻高流量湿化氧疗治疗,在治疗前、治疗后6 h、12 h、24 h观察并记录两组患者心率(HR)、呼吸频率(RR)、平均动脉压(MAP),血气分析中pH值、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)等指标,统计气管插管率、总通气时间、ICU住院时间、口咽部不适及面部皮肤损伤发生率等指标。结果两组患者经治疗后PaCO2均下降,pH值及PaO2均上升,治疗过程中试验组患者呼吸频率下降较对照组明显,口咽部不适发生率低于对照组,差异有统计学意义(P<0.05)。两组患者ICU住院时间比较,差异无统计学意义(P>0.05)。结论经鼻高流量湿化氧疗治疗合并高碳酸血症的COPD患者,可以改善患者的通气功能,与无创通气相比,治疗过程中患者舒适度和依从性更好。

Objective To investigate the efficacy of nasal high-flow humidification oxygen therapy in chronic obstructive pulmonary disease(COPD)patients complicated with hypercapnia.Methods A total of 30 patients with COPD admitted to our hospital from May 2017 to October 2019 were selected as the research objects,and they were randomly divided into the control group(n=15)and the study group(n=15).Both groups were treated with conventional drugs,and the control group was treated with noninvasive ventilation while the study group was treated with high-flow humidification oxygen therapy.Heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),and pH value,arterial oxygen partial pressure(PaO2),carbon dioxide partial pressure(PaCO2)and other indexes in blood gas analysis were observed and recorded,as well as tracheal intubation rate,total ventilation time,ICU hospitalization time,oropharyngeal discomfort and the incidence of facial skin injury were statistically recorded before treatment,6 hours,12 hours and 24 hours after treatment.Results After treatment,PaCO2 decreased in both groups,while pH value and PaO2 both increased.During the treatment,the RR in the high-flow humidification oxygen therapy group decreased more obviously than that in the non-invasive ventilation group,and the incidence of oropharyngeal discomfort was lower than that in the non-invasive ventilation group,with statistically significant differences(P<0.05).There was no significant difference in ICU hospitalization time between the two groups(P>0.05).Conclusion High-flow humidification oxygen therapy can improve the ventilation function of COPD patients complicated with hypercapnia.Compared with non-invasive ventilation,the comfort and compliance of patients in the treatment process are better.