无创高频振荡通气在中-重度慢性阻塞性肺疾病急性加重期伴呼吸衰竭患者中的应用

Application of Non-invasive High Frequency Oscillatory Ventilation in the Treatment of Patients with Moderate to Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Respiratory Failure

目的研究无创高频振荡通气治疗对中-重度慢性阻塞性肺疾病急性加重期(AECOPD)伴呼吸衰竭患者炎性指标及痰液性状的影响。方法选取2019年1月至2020年6月在绵阳市第三人民医院·四川省精神卫生中心呼吸与危重症医学科就诊的100例中-重度AECOPD伴呼吸衰竭患者为研究对象,按随机数字表法分为双相气道正压通气(BiPAP)组和无创高频振荡通气(NHFOV)组,每组50例。两组于治疗前及治疗后72 h采集清晨空腹静脉血,经全自动血液分析仪检测白细胞(WBC)水平,透射比浊法检测患者C-反应蛋白(CRP)水平,电化学发光法检测患者降钙素原(PCT)水平,比较两组WBC、CRP、PCT等炎症指标;痰液量、性状及颜色改变。结果治疗后,NHFOV组PCT、CRP值明显低于BiPAP组(P<0.05);两组WBC比较,差异无统计学意义(P>0.05);NHFOV组痰液性状改变时间、平均24 h排痰量较BiPAP组明显降低(P<0.05)。结论在中-重度AECOPD伴呼吸衰竭患者治疗中,NHFOV较常规BiPAP更能减轻炎性反应,减少痰液量,改善患者症状。

Objective To investigate the effect of non-invasive high-frequency oscillatory ventilation(NHFOV)on inflammatory indicators and sputum in patients with moderate to severe acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure.Methods A total of 100 patients with moderate to severe AECOPD with respiratory failure admitted to the department of respiratory and critical care medicine of the Third People′sHospital of Mianyang City(Sichuan Mental Health Center)from January 2019 to June 2020 were enrolled.According to the way of ventilation,they were randomly divided into bilevel positive airway pressure(BiPAP)group(n=50)and NHFOV group(n=50).Fasting venous blood was collected in the morning in both groups before and 72 hours after treatment.The level of white blood cells(WBC)was detected by automatic hematology analyzer,the level of C-reactive protein(CRP)by transmission turbidimetry,and the level of procalcitonin(PCT)by electrochemiluminescence.Inflammatory indicators such as WBC,CRP,and PCT,and volume,character and color changes of sputum were compared between the two groups before and after treatment.Results NHFOV group had lower PCT and CRP compared with BiPAP group(P<0.05).There was no statistical significance in WBC between the two groups(P>0.05).The time required for the improvement of sputum properties and the average volume of sputum excretion in 24 h in NHFOV group were significantly lower than those in BiPAP group(P<0.05).Conclusion NHFOV is better than BiPAP in alleviating inflammatory response,reducing sputum volume and improving symptoms in the treatment of patients with moderate to severe AECOPD with respiratory failure.