经鼻高流量湿化氧疗与无创正压通气治疗AECOPD并发呼吸衰竭对血气分析指标及氧化应激的影响

Effects of high⁃flow nasal cannula oxygen therapy and non⁃invasive positive pressure ventilation on blood gas analysis indexes and oxidative stress in treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure

目的探究经鼻高流量湿化氧疗(high‐flow nasal cannula oxygen therapy,HFNC)与无创正压通气(non‐invasive positive pressure ventilation,NPPV)治疗慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)并发呼吸衰竭对血气分析(blood gas analysis,BG)指标及氧化应激(oxidative stress,OS)的影响。方法回顾性分析南通大学附属如皋医院2019年6月至2021年6月收治的119例AECOPD并发Ⅱ型呼吸衰竭患者临床资料,依据其治疗方式不同分为2组,其中采用HFNC治疗的63例患者为HFNC组,行NPPV治疗的56例患者为NPPV组。收集对比2组患者治疗前以及治疗3 d后动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))、动脉二氧化碳分压(arterial carbon dioxide partial pressure,PaCO_(2))、血氧饱和度(blood oxygen saturation,SaO_(2))、动脉血氢离子浓度指数(hydrogen ion concentration,pH)与血清丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH‐Px)水平资料以及2组患者治疗过程中不良反应发生情况。结果治疗3 d后,2组患者的BG指标水平均有所改善,HFNC组患者的PaO_(2)、SaO_(2)、pH水平相较于NPPV组明显更高,而PaCO_(2)水平明显更低(P<0.05)。治疗3 d后,2组患者的OS指标水平均有所改善,HFNC组患者的SOD、GSH‐Px水平相较于NPPV组明显更高,而MDAd水平明显更低(P<0.05);治疗过程中HFNC组的不良反应发生率为6.35%,明显低于NPPV组的60.71%(P<0.05)。结论HFNC与NPPV用于治疗AECOPD并发Ⅱ型呼吸衰竭患者,均有良好的疗效,但HFNC对患者BG指标及OS改善效果更好,不良反应发生率更低。

Objective To investigate the effects of high‐flow nasal cannula oxygen therapy and non‐invasive positive pressure ventilation on blood gas analysis indexes and oxidative stress(OS)in treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure.Methods The clinical data of 119 patients with AECOPD complicated with type Ⅱ respiratory failure treated in the hospital from June 2019 to June 2021 were retrospectively analyzed.The patients were divided into 2 groups according to different treatment methods.The 63 patients treated with high‐flow nasal cannula were designated as the oxygen therapy group(or the HFNC group),while the 56 patients treated with noninvasive positive pressure ventilation(NPPV)were signed as the NPPV group.The levels of arterial partial pressure of oxygen(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),blood oxygen saturation(SaO_(2)),arterial blood hydrogen ion concentration(pH),and malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione peroxidase(GSH‐Px)before treatment and 3 days after treatment were detected and compared between the two groups.Adverse reactions during treatment were also analyzed and compared between the two groups of patients.Results After 3 days of treatment,the blood gas levels in the patients of the two groups improved,with the levels of PaO_(2),SaO_(2) and pH in the patients of the HFNC group being significantly higher than those in the patients of the NPPV group,while the levels of PaCO_(2) was significantly lower(P<0.05).Following 3 days of treatment,the OS levels in the patients of the two groups all improved to a certain extent,and the levels of SOD and GSH‐Px in the patients of the HFNC group were significantly higher than those in the NPPV group,while the MDA level was significantly lower(P<0.05).During treatment,the adverse reaction rate of the HFNC group was 6.35%,which was significantly lower than that of NPPV(60.71%)(P<0.05).Conclusion The application of HFNC and NPPV could all achieve good effects in the patients with AECOPD complicated with type Ⅱ respiratory failure,with HFNC having a higher effect on the improvement of blood and OS,and with a lower rate of adverse reactions.