经鼻高流量湿化氧疗与无创正压通气在改善AECOPD患者二氧化碳潴留临床疗效的比较

High-flow Nasal Cannual Oxygen Therapy Compared with Non-invasive Ventilation For Improving Carbon Dioxide Retention in Patients with AECOPD

目的:经鼻高流量氧疗(HFNC)已广泛应用于缺氧性呼吸衰竭患者的治疗。本研究分析了HFNC治疗对慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的治疗效果。方法:本研究前瞻性观察分析了2017年1月至2019年1月入住我院呼吸科和重症医学科,诊断为AECOPD且合并有中度II型呼吸衰竭(血气分析PaO_(2)/Fi O2<200 mm Hg,PaCO_(2)>45 mm Hg,pH7.25~7.35)的患者44例,随机平均分为两组,参照组22例患者采纳无创正压通气(NIV)技术治疗,实验组22例患者予以HFNC治疗。观察两组患者治疗效果(治疗失败改为有创通气、28天死亡率)、血气分析对比血pH、PaCO_(2)、PaO_(2)。结果:HFNC组患者(22例,平均年龄73岁,男性占63.6%)同NIV组患者(22例,平均年龄77岁,男性占54.5%)相比,血pH、PaCO_(2)、PaO_(2)等血气分析指标两组无显著统计学差异。治疗失败率分别为22.7%(5/22)和27.2%(6/22),P=0.857。28天死亡率无统计学差异(HFNC组为13.6%,NIV组为18.2%,P=0.845)。结论:在AECOPD合并Ⅱ型呼吸衰竭的患者中,HFNC在改善氧合缓解CO2潴留方面具有同NIV相似的效应,因其具有更好的舒适性和耐受性,可成为NIV的有益补充。

Objective:High-flow Nasal Cannula therapy(HFNC)has been widely used in the treatment of hypoxic respiratory failure.The objective of this study is to analyzed the therapeutic effect of HFNC on AECOPD(acute exacerbation of chronic obstructive pulmonary disease)complicated with typeⅡrespiratory failure.Methods:This study prospectively observed and analyzed 44 patients who were admitted to the respiratory department and critical medicine department of our hospital from January 2017 to January2019,and diagnosed as AECOPD and complicated with moderate typeⅡrespiratory failure(blood gas analysis showed that PaO_(2)/Fi O2<200 mm Hg,PaCO_(2)>45 mm Hg,pH7.25~7.35).They were randomly divided into two groups.22 patients in the control group were treated with NIV(non-invasive ventilation),and 22 patients in the experimental group were treated with HFNC.The therapeutic effects of the two groups were observed(the treatment failed and was changed to invasive ventilation,28-day mortality),blood pH,PaCO_(2) and PaO_(2) of the two groups were compared.Results:There was no significant difference in blood gas analysis indexes such as pH,PaCO_(2) and PaO_(2) between HFNC group(22 cases,average age 73 years old,male accounted for 63.6%)and NIV group(22 cases,average age 77 tears,male 54.5%).The treatment failure rates were 22.7%(5/22)and 27.2%(6/22)respectively(P=0.857).There was no statistical difference in 28-day mortality(13.6%in the HFNC group and 18.2%in the NIV group,P=0.845).Conclusions:In patients with AECOPD complicated with typeⅡrespiratory failure,HFNC has a similar effect as NIV in improving oxygenation and alleviating CO2 retention.Because of its better comfort and tolerance,it can be a useful supplement to NIV.