NIV、HFOT对COPD合并呼吸道感染患者呼吸动力学的影响

EFFECTS OF NIV AND HFOT ON RESPIRATORY DYNAMICS OF COPD PATIENTS WITH RESPIRATORY TRACT INFECTION

目的探讨慢性阻塞性肺疾病(COPD)合并呼吸道感染患者拔管后给予无创通气(NIV)、经鼻高流量氧疗(HFOT)序贯治疗对呼吸动力学的影响。方法回顾性分析2016年6月—2020年1月该院收治的87例COPD合并呼吸道感染患者的临床资料,按序贯通气方案进行分组给予NIV患者为NIV组(43例),给予HFOT患者为HFOT组(44例)。比较二组并发症发生率、舒适度、治疗前及治疗2 h、24 h后血气状态[pH值、动脉血二氧化碳分压(PaCO2)、血氧分压(PaO2)、氧合指数(OI)]、呼吸动力学[气道阻力(Raw)、肺静态顺应性(Cs)、肺动态顺应性(Cd)、内源性呼气末正压(PEEPi)]、膈肌功能[深呼吸膈肌移动度(DEd)、平静呼吸膈肌移动度(DEq)、膈肌浅快呼吸指数(D-RSBI)],停止肠内营养6 h后营养状态[血清白蛋白、前白蛋白、总蛋白水平]。结果治疗2 h、24 h后二组Raw、PEEPi均降低,Cs、Cd均升高,但组间比较,差异均无统计学意义(均P>0.05);治疗2h、24h后二组pH值、PaO2、OI、DEd均升高,HFOT组高于NIV组,DEq、DRSBI、PaCO2均降低,HFOT组低于NIV组,且HFOT组改善更迅速(均P<0.05);停止肠内营养6h后二组血清白蛋白、前白蛋白、总蛋白水平均降低,但HFOT组高于NIV组(P<0.05);HFOT组舒适度优于NIV组(P<0.05);二组并发症发生率比较,差异无统计学意义(P>0.05)。结论与NIV比较,HFOT可有效改善COPD合并呼吸道感染患者呼吸动力学,进一步提升膈肌功能,且利于维持机体营养状态,提高舒适性,控制并发症发生风险。

Objective To investigate the effects of sequential non-invasive ventilation(NIV) and nasal high-flow oxygen therapy(HFOT) on respiratory dynamics in patients with chronic obstructive pulmonary disease(COPD) complicated with respiratory infection after extubation.Methods A total of eighty-seven patients with COPD combined with respiratory tract infection in Fourth Affiliated Hospital of Nanjing Medical University from June 2016 to January 2020 were selected,and they were divided into the NIV group(43 cases) and HFOT group(44 cases) according to the sequential ventilation protocol.The complication rate,comfort level,blood gas state(pH value,PaCO2,PaO2,OI) before and at 2 h and 24 h after treatment,respiratory dynamics(Raw,Cs,Cd,PEEPi),diaphragm function(DEd,DEq,D-RSBI) before and at 2 h and 24 h after treatment,and nutritional status(serum albumin,prealbumin,total protein level) at 6 h of enteral nutrition cessation were compared between the two groups.Results After 2 h and 24 h of treatment,Raw and PEEPi decreased in both groups,and Cs and Cd increased,but there was no significant difference between the groups(P>0.05);after 2 h and 24 h of treatment,the pH value,PaO2,OI,and DEd of the two groups increased,the HFOT group was higher than the NIV group,and DEq,D-RSBI and PaCO2 all decreased,the HFOT group was lower than the NIV group,and the HFOT group improved more rapidly(P<0.05);6 h after stopping enteral nutrition,the levels of serum albumin,prealbumin and total protein decreased in the two groups,butthe HFOT group was higher than the NIV group(P<0.05);the comfort of the HFOT group was better than that of the NIV group(P<0.05);there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Compared with NIV,HFOT can effectively improve the respiratory dynamics of patients with COPD combined with respiratory infections,further improve diaphragm function,and help maintain the nutritional status of the body,improve comfort and control the risk of complications.