经鼻高流量氧疗与有创-无创通气序贯疗法治疗COPD合并Ⅱ型呼吸衰竭的效果及近期预后比较

Comparison of the Efficacy and Short-term Prognosis of Transnasal High Flow Oxygen Therapy and Invasive Non-invasive Sequential Ventilation Therapy in the Treatment of COPD Complicated with Type Ⅱ Respiratory Failure

目的:对比经鼻高流量氧疗(HFNC)与有创-无创通气序贯疗法治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的效果及近期预后。方法:以2019年1月-2021年12月某院收治的67例住院COPD合并Ⅱ型呼吸衰竭患者作为研究对象,采取随机数字表法将其分为A组(n=34)和B组(n=33),A组采用HFNC治疗,B组采用有创-无创通气序贯疗法治疗,比较两组患者临床疗效与近期预后。结果:治疗后,B组患者治疗失败率、病死率低于A组患者(P<0.05);治疗1 d、2 d后,B组患者二氧化碳分压(PaCO_(2))、降钙素原(PCT)、C反应蛋白(CRP)低于A组患者(P<0.05),B组患者氧分压(PaO_(2))、酸碱值(pH)高于A组患者(P<0.05);治疗5 d后,B组患者PaCO_(2)、CRP低于A组患者(P<0.05),PaO_(2)高于A组患者(P<0.05),但B组患者pH、PCT与A组患者比较无明显差异(P>0.05);治疗后,B组患者总通气时间、重症监护室(ICU)治疗时间、总住院时间短于A组患者(P<0.05),B组患者气道护理干预次数少于A组患者(P<0.05);治疗后,B组患者健康状况调查问卷(SF-36)各维度评分高于A组患者(P<0.05)。结论:有创-无创通气序贯疗法治疗COPD合并Ⅱ型呼吸衰竭,其临床疗效、近期预后和生活质量均优于HFNC治疗。

Objective:To compare the efficacy and short-term prognosis of transnasal high flow oxygen therapy(HFNC)and invasive noninvasive sequential ventilation therapy in the treatment of chronic obstructive pulmonary disease(COPD)complicated with type Ⅱ respiratory failure.Methods:67 inpatients with COPD complicated with type Ⅱ respiratory failure treated in a hospital from January 2019 to December 2021 were selected as the research objects and divided into group A(n=34 cases)and group B(n=33 cases)by random number table method.Group A was treated with HFNC and group B was treated with invasive non-invasive sequential ventilation.The clinical efficacy and short-term prognosis of the two groups were compared.Results:After treatment,the treatment failure rate and mortality in group B were lower than those in group A(P<0.05).After 1 and 2 days of treatment,the partial pressure of carbon dioxide(PaCO_(2)),procalcitonin(PCT)and C-reactive protein(CRP)in group B were lower than those in group A(P<0.05),and the partial pressure of oxygen(PaO_(2))and pH in group B were higher than those in group A(P<0.05).After 5 days of treatment,PaCO_(2) and CRP in group B were lower than those in group A(P<0.05),PaO_(2) was higher than that in group A(P<0.05),but there was no significant difference in pH and PCT between the two groups(P>0.05).After treatment,the total ventilation time,ICU treatment time and total hospitalization time of group B were shorter than those of group A(P<0.05),and the times of airway nursing intervention in group B was less than that in group A(P<0.05).After treatment,the score of SF-36 in each dimension in group B was higher than that in group A(P<0.05).Conclusion:The clinical efficacy,short-term prognosis and quality of life of invasive non-invasive sequential ventilation therapy is superior to HFNC in the treatment of COPD complicated with type Ⅱ respiratory failure.