经鼻高流量氧疗在慢性阻塞性肺疾病急性加重无创通气后序贯治疗中的应用效果

Effect of high-flow nasal cannula oxygen therapy in sequential treatment of patients with acute exacerbation of chronic obstructive pulmonary disease after non-invasive ventilation

目的 探讨经鼻高流量氧疗(HFNC)在慢性阻塞性肺疾病急性加重(AECOPD)无创通气(NIV)后序贯治疗中的应用效果.方法 选择2020年1月至2021年12月颍上县人民医院呼吸科收治的83例AECOPD需NIV患者作为研究对象.按随机数字表法将患者分为HFNC组(43例)和传统氧疗组(40例).所有入组患者均给予AECOPD的常规治疗;HFNC组患者在NIV间歇期应用HFNC进行序贯氧疗,初始温度设置为34℃,气流速设置为30 L/min,根据患者耐受情况逐步上调温度至37℃,气流速设置为60 L/min,吸入氧浓度(FiO2)根据患者脉搏血氧饱和度(SpO2)进行调节,维持SpO2在0.88~0.92;传统氧疗组患者在NIV间歇期应用鼻导管吸氧,氧流量根据患者SpO2进行调节,维持SpO2在0.88~0.92.比较两组患者总呼吸支持时间、NIV每日平均使用时间、NIV间歇次数、NIV治疗失败率、气管插管率、住院时间的差异,并分析治疗失败的原因.结果 HFNC组总呼吸支持时间、NIV每日平均使用时间、NIV间歇次数、NIV治疗失败率均明显低于传统氧疗组〔总呼吸支持时间(d):5.21±0.97比5.98±1.70,NIV每日平均使用时间(h):7.95±2.52比10.45±3.80,NIV间歇次数(次):6.58±1.03比7.38±1.23,治疗失败率:13.95%(6/43)比35.00%(14/40),均P<0.05〕;传统氧疗组和HFNC组气管插管率及住院时间比较差异均无统计学意义〔气管插管率:12.50%(5/40)比6.98%(3/43),住院时间(d):10(8,11)比9(8,10),均P>0.05〕.在治疗失败的原因中,传统氧疗组呼吸困难加重率和CO_(2)潴留加重率均明显高于HFNC组〔呼吸困难加重率:12.50%(5/40)比2.33%(1/43),CO_(2)潴留加重率:17.50%(7/40)比2.33%(1/43),均P<0.05〕;传统氧疗组和HFNC组不耐受率及低氧血症加重率比较差异均无统计学意义〔不耐受率:2.50%(1/40)比6.98%(3/43),低氧血症加重率:0%(0/40)比2.33%(1/43),均P>0.05〕.结论 HFNC在AECOPD应用NIV后序贯治疗可以改善呼吸肌疲劳,减少呼吸功耗,缩短呼吸支持时间,降低CO_(2)潴留,改善呼吸性酸中毒.

Objective To investigate the effect of high-flow nasal cannula oxygen therapy(HFNC)in the sequential treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)after noninvasive ventilation(NIV).Methods,A total of 83 patients with AECOPD requiring NIV who were admitted to the Department of Respiration in the People's Hospital of Yingshang County from January 2020 to December 2021 were selected as the research subjects.The patients were divided into a HFNC group(43 cases)and a traditional oxygen therapy group(40 cases)according to the random number table method.Allthe enrlled patients were given the routine treatment of AECOPD;the patients in the HFNC group were given HFNC for sequential oxygen therapy during the NIV intermitent stage,the initial temperature was set at 34 C and the air flow rate was set at 30 L/min,and the temperature was gradully increased to 37 C according to the patient's tolerance,the airflow rate was set to 60 Lmin,and the fraction of inspiration oxygen(FiO_(2))was adjusted according to the patient's pulse oxygen saturation(SpO_(2))to maintain SpO_(2)at 0.88-0.92;the patients in the traditional oxygen therapy group were inhaled oxygen by nasal cannula during the intermittent period of using NIV,and the oxygen flow rate was adjusted according to the patient's SpOz,and the SpO_(2)was maintained at 0.88-0.92.The diferences in total respiratory support time,average daily NIV use time,number of NIV intermitent frequency,NIV treatment failure rate,tracheal intubation rate,and hospital length of stay were compared between the two groups,and the reasons of treatment failure were analyzed.Results The total respiratory support time,average daily NIV use time,number of NIV intermitent frequency and NIV treatment failure rate in the HFNC group were significantly lower than those in traditional oxygen therapy group[total respiratory support time(days):5.21±0.97 vs.5.98±1.70,the average daily NIV use time(hours):7.95±2.52 vs.10.45±3.80,and the number of NIV intermitent frequency(times):6.58±1.03 vs.7.38±1.23)and NIV treatment failure rate[13.95%(6/43)vs.35.00%(14/40),all P<0.05].There were no statistically significant dfferences in tracheal intubation rate and hospital length of stay between the traditional oxygen therapy and HFNC groups[racheal intubation rate:12.50%(5/40)vs.6.98%(3/43),length of hospital stay(days):10(8,11)vs.9(8,10),both P>0.05).Among the reasons for treatment failure,the rates of exacerbation of dyspnea and cO,retention were significantly higher in the traditional oxygen therapy group than those in the HFNC group[rate of exacerbation of dyspnea:12.50%(5/40)vs.2.33%(1/43),rate of exacerbation of CO0,retention:17.50%(7/40)vs.2.33%(1/43),both P<0.05).There were no statistically significant differences between tradional oxygen therapy group and HFNC group in terms of intolerance rate and hypoxemia exacerbation rate[intolerance rate:2.50%(1/40)vs.6.98%(3/43),and hypoxemia exacerbation rate:0%(0/40)vs.2.33%(1/43),both P>0.05).ConclusionSequential treatment of AECOPD patients with HFNC afer NIV can relieve respiratory muscle fatigue,reduce respiratory power consumption,shorten respiratory supportime,reduce CO,retention and respiratory acidosis.