经鼻高流量氧疗治疗慢性阻塞性肺疾病合并高碳酸血症性呼吸衰竭患者的有效性和安全性分析

Efficacy and safety of high-flow nasal cannula therapy in patients with chronic obstructive pulmonary disease complicated with hypercapnia respiratory failure

目的:探讨经鼻高流量氧疗(HFNC)治疗慢性阻塞性肺疾病合并高碳酸血症性呼吸衰竭患者的有效性和安全性分析。方法:以2017年5月至2019年4月于本院重症监护室住院治疗的50例慢性阻塞性肺疾病合并高碳酸血症性呼吸衰竭患者作为研究对象。根据随机数字表法,将患者分为HFNC组和无创通气(NIV)组,各25例,比较2组患者治疗前、治疗24 h、48 h以及72 h后的动脉血酸碱度(pH)、二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))。结果:HFNC组和NIV组各时间点PaCO_(2)和PaO_(2)/FiO_(2)差异均有统计学意义(P<0.05);氧疗方式与时间交互作用下差异均无统计学意义(P>0.05)。阻塞性睡眠呼吸暂停综合征(OSA)+HFNC患者与OSA+NIV患者不同时间点PaCO_(2)、PaO_(2)/FiO_(2)差值无统计学意义(P>0.05),时间和氧疗方法交互作用下2组患者PaCO_(2)、PaO_(2)/FiO_(2)差值具有统计学意义(P<0.05),差值比较显示,OSA+HFNC患者24 h、48 h PaCO_(2),24 h、48 h、72 h PaO_(2)/FiO_(2)差值相比OSA+NIV患者增加。结论:HFNC和NIV均可有效改善慢性阻塞性肺疾病合并高碳酸血症性呼吸衰竭患者肺通气状态,其中HFNC更有利于合并有OSA患者的治疗。

Objective:To investigate the efficacy and safety of high-flow nasal cannula(HFNC)in the treatment of chronic obstructive pulmonary disease(COPD)with hypercapnia respiratory failure.Methods:A total of 50 patients with COPD complicated with hypercapnia respiratory failure who were hospitalized in the intensive care unit of our hospital from May 2017 to Apr 2019 were selected as the research objects.According to the random number table method,the patients were divided into HFNC group and non-invasive ventilation(NIV)group,25 cases in each group.pH,PaCO_(2) and PaO_(2)/FiO_(2) were measured and analyzed statistically.Results:There were statistically significant differences in PaCO_(2) and PaO_(2)/FiO_(2) between HFNC group and NIV group at each time point(P<0.05).There was no statistical significance in the interaction between oxygen therapy and time(P>0.05).The difference of PaCO_(2) and PaO_(2)/FiO_(2) between OSA+HFNC patients and OSA+NIV patients at different time points was not statistically significant(P>0.05),while under the interaction of time and oxygen therapy method,the difference was statistically significant(P<0.05).Compared with OSA+NIV patients,the differences of PaCO_(2) at 24 h,48 h and PaO_(2)/FiO_(2) at 24 h,48 h and 72 h in OSA+HFNC patients increased.Conclusion:HFNC and NIV can effectively improve the pulmonary ventilation status of patients with COPD complicated with hypercapnia respiratory failure,and HFNC is more conducive to the treatment of patients with OSA.