经鼻高流量湿化氧疗与无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的疗效比较

Effect of high-flow nasal cannula oxygen therapy and noninvasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure

目的比较经鼻高流量湿化氧疗(HFNC)与无创正压通气(NPPV)在慢性阻塞性肺疾病急性加重期(AECOPD)并发Ⅱ型呼吸衰竭中的疗效。方法选取2017年10月至2019年12月湖南省湘潭市第一人民医院收治的AECOPD并发Ⅱ型呼吸衰竭患者160例,根据随机数字表法将其分为NPPV组和HFNC组,各80例。HFNC组在常规抗感染等治疗基础上采用HFNC治疗,NPPV组在常规抗感染等治疗基础上采用NPPV治疗,比较2组患者治疗前后呼吸频率、心率、平均动脉压(MAP)、血气分析指标、视觉模拟量表(VAS)评分及并发症发生率。结果治疗后24、48 h,2组患者呼吸频率、心率及动脉血二氧化碳分压均低于治疗前,MAP、动脉血氧分压及p H值均高于治疗前(均P<0.05),但同时点组间比较,差异均无统计学意义(均P>0.05)。HFNC组VAS评分、并发症发生率均低于NPPV组[(2.9±0.3)分比(3.9±1.5)分、6.2%(5/80)比15.0%(12/80),均P<0.05]。结论采用HFNC治疗AECOPD并发Ⅱ型呼吸衰竭具有与NPPV相似的疗效,并可降低并发症发生率,提高患者舒适度。

Objective To compare the curative effect of high-flow nasal cannula oxygen therapy(HFNC) and noninvasive positive pressure ventilation(NPPV)in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with typeⅡrespiratory failure.Methods From October 2017 to December 2019,160 AECOPD patients with typeⅡrespiratory failure admitted to the First People’s Hospital of Xiangtan City,Hunan Province were selected.The patients were randomly divided into NPPV group and HFNC group,with 80 cases in each group.HFNC group was treated with HFNC on the basis of routine anti-infection treatment,and NPPV group was treated with NPPV on the basis of routine anti-infection treatment.Breathing rate,heart rate,mean arterial pressure(MAP),blood gas analysis indexes,visual analogue scale(VAS)score and incidence of complications were compared between the two groups.Results At 24 and 48 h after treatment,the respiratory rate,heart rate and arterial partial pressure of carbon dioxide of the two groups were lower than before treatment,while MAP,arterial partial pressure of oxygen and p H value were higher than before treatment(all P<0.05),but there were no statistically significant differences between the two groups at each time point(all P>0.05).VAS score and incidence of complication in HFNC group were lower than those in NPPV group[(2.9±0.3)vs(3.9±1.5),6.2%(5/80)vs 15.0%(12/80),both P<0.05].Conclusion There was similar curative effect of HFNC and NPPV treated on AECOPD patients complicated with typeⅡrespiratory failure,and HFNC can reduce the incidence of complications and improve the comfort of the patients.