对COPD合并Ⅱ型呼吸衰竭气管插管拔管后患者进行经鼻高流量湿化氧疗的效果研究

To study the effect of nasal high flow humidified oxygen therapy on patients with COPD complicated with type ⅱ respiratory failure after tracheal intubation and extubation

目的:比较在慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭气管插管患者拔管后对其进行经鼻高流量湿化吸氧(HHFNC)与无创正压通气(NPPV)治疗的临床效果及安全性。方法:选取2018年1月至2021年1月在无锡市人民医院接受气管插管机械通气治疗并已拔除气管插管的COPD合并Ⅱ型呼吸衰竭患者116例作为研究对象。采用随机数表法将其分为A组和B组。对A组患者进行HHFNC治疗,对B组患者进行NPPV治疗。然后比较治疗前、治疗后2 h、治疗12 h后、治疗24 h后、治疗结束时两组患者的动脉血气指标及其再次插管率、气管切开率、住ICU的时间、并发症的发生率、死亡率。结果:从治疗2 h后、治疗12 h后、治疗24 h后到治疗结束时,两组患者的PaO_(2)、PaO_(2)/FiO_(2)逐渐提高,其PaCO_(2)逐渐下降。与治疗前相比,治疗2 h后、治疗12 h后、治疗24 h后、治疗结束时两组患者的PaO_(2)、PaO_(2)/FiO_(2)均较高,其PaCO_(2)均较低,差异均有统计学意义(P<0.05)。治疗2 h后、治疗12 h后、治疗24 h后,A组患者的PaO_(2)、PaO_(2)/FiO_(2)均高于B组患者,其PaCO_(2)均低于B组患者,差异均有统计学意义(P<0.05)。治疗后,两组患者的再次插管率、气管切开率、死亡率相比较,差异均无统计学意义(P>0.05);A组患者并发症的发生率低于B组患者,差异有统计学意义(P<0.05)。两组患者住ICU的时间相比较,差异无统计学意义(t=0.22,P>0.05)。结论:与进行NPPV治疗相比,在COPD合并Ⅱ型呼吸衰竭气管插管患者拔管后对其进行HHFNC治疗的短期临床效果及安全性均较优。

Objective:To compare the clinical efficacy and safety of nasal high flow humidified oxygen(HHFNC)and noninvasive positive pressure ventilation(NPPV)after extubation in patients with chronic obstructive pulmonary disease(COPD)complicated with typeⅱrespiratory failure.Methods:A total of 116 COPD patients with type ii respiratory failure who received tracheal intubation mechanical ventilation in Wuxi People’s Hospital from January 2018 to January 2021 and had tracheal intubation removed were selected as the research objects.They were divided into group A and group B by random number table method.Patients in group A were treated with HHFNC and patients in group B were treated with NPPV.Then,the arterial blood gas indexes,re-intubation rate,tracheotomy rate,length of stay in ICU,incidence of complications and mortality of 2 groups were compared before treatment,2 h after treatment,12 h after treatment,24 h after treatment and at the end of treatment.Results:PaO_(2) and PaO_(2)/FiO_(2) increased and PaCO_(2) decreased from 2 h after treatment,12 h after treatment,24 h after treatment to the end of treatment.Compared with before treatment,2 h after treatment,12 h after treatment,24 h after treatment PaO_(2) and PaO_(2)/FiO_(2) were higher and PaCO_(2) was lower in both groups at the end of treatment,with statistical significance(P<0.05).PaO_(2) and PaO_(2)/FiO_(2) in group A were higher than those in group B,and PaCO_(2) was lower than those in group B after 2 h,12 h and 24 h treatment,with statistical significance(P<0.05).After treatment,there were no significant differences in re-intubation rate,tracheotomy rate and mortality between 2 groups(P>0.05).The incidence of complications in group A was lower than that in group B,the difference was statistically significant(P<0.05).There was no significant difference in the length of ICU stay between 2 groups(t=0.22,P>0.05).Conclusion:Compared with NPPV treatment,HHFNC treatment after extubation of tracheal intubation patients with COPD complicated with typeⅱrespirato ry failure has better short-term clinical effect and safety.