经鼻高流量湿化氧疗治疗AECOPD合并重症肺炎的疗效及安全性研究

Efficacy and safety of nasal high-flow humidified oxygen therapy in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with severe pneumonia.

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)合并重症肺炎患者应用经鼻高流量湿化氧疗(HFNC)治疗的疗效及安全性。方法选择2020年6月至2021年7月上海交通大学医学院附属第九人民医院黄浦分院急诊科接诊的60例AECOPD合并重症肺炎患者进行研究,按随机数表法分为观察组和对照组各30例。两组患者均给予常规治疗,对照组同时给予无创正压通气(NIPPV)治疗,观察组则同时给予HFNC治疗,两组患者均连续治疗1周。比较两组患者治疗前和治疗1周后的炎症因子[白介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)]、肺功能指标[第一秒最大呼气容积(FEV1)、FEV1与用力肺活量比值(FEV1/FVC)%、最大呼气流量(PEF)]、动脉血气指标[动脉氧分压(PaO_(2))、动脉二氧化碳(PaCO_(2))、血氧饱和度(SpO_(2))]的变化,并记录治疗后两组患者的并发症发生情况。结果治疗1周后,观察组患者的血清IL-6、PCT、CRP水平分别为(15.35±3.23)pg/mL、(1.09±0.16)ng/mL、(24.19±3.06)mg/L,明显低于对照组的(26.18±5.30)pg/mL、(2.74±0.30)ng/mL、(40.42±5.50)mg/L,差异均有统计学意义(P<0.05);治疗1周后,观察组患者的FEV1、FEV1/FVC、PEF、PaO_(2)、SpO_(2)水平分别为(1.85±0.36)L、(73.64±6.73)%、(3.98±1.34)L/s、(88.46±6.73)mmHg、(86.25±12.31)%,明显高于对照组的(1.53±0.38)L、(61.48±6.24)%、(3.16±1.38)L/s、(82.33±7.94)mmHg、(78.37±13.62)%,PaCO_(2)水平为(34.30±8.51)mmHg,明显低于对照组的(40.62±6.44)mmHg,差异均有统计学意义(P<0.05);观察组患者的心肺功能障碍、低血压的发生率分别是40.00%、14.00%,明显低于对照组的66.67%、76.67%,差异均有统计学意义(P<0.05);而两组患者的贫血发生率比较差异无统计学意义(P>0.05)。结论应用HFNC治疗AECOPD合并重症肺炎能降低患者的炎症反应,促进肺功能恢复,改善血气指标,且并发症少,具有临床应用价值。

Objective To investigate the efficacy and safety of transnasal high-flow humidified oxygen therapy(HFNC)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with severe pneumonia.Methods Sixty patients with AECOPD complicated with severe pneumonia who were admitted to the Emergency Department,Huangpu Branch of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2020 to July 2021 were selected for the study,which were divided into an observation group and a control group by random number table method,with 30 patients in each group.Based on conventional treat ment measures,patients in the control group were treated with non-invasive positive pressure ventilation(NIPPV),and patients in the observation group were treated with HFNC,both for 1 week.Before and after 1 week of treatment,the inflammatory factors[interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)],pulmonary function indicators[maximum expiratory volume in the first second(FEV1),ratio of FEV1 to forced vital capacity(FEV1/FVC)%,peak expiratory flow(PEF)],arterial blood gas indicators[arterial partial pressure of oxygen(PaO_(2)),arterial carbon dioxide(PaCO_(2)),blood oxygen saturation(SpO_(2))]changes were compared between the two groups,and the complications after treatment were recorded.Results One week after treatment,the serum IL-6,PCT,and CRP levels in the observation group were(15.35±3.23)pg/mL,(1.09±0.16)ng/mL,and(24.19±3.06)mg/L,which were significantly lower than(26.18±5.30)pg/mL,(2.74±0.30)ng/mL,(40.42±5.50)mg/L in the control group(P<0.05);the levels of FEV1,FEV1/FVC,PEF,PaO_(2),and SpO_(2) in the observation group were(1.85±0.36)L,(73.64±6.73)%,(3.98±1.34)L/s,(88.46±6.73)mmHg,(86.25±12.31)%,respectively,significantly higher than(1.53±0.38)L,(61.48±6.24)%,(3.16±1.38)L/s,(82.33±7.94)mmHg,(78.37±13.62)%in the control group;PaCO_(2) level was(34.30±8.51)mmHg,significantly lower than(40.62±6.44)mmHg in the control group;the differences were statistically significant(P<0.05).The incidence of cardiopulmonary dysfunction,hypotension in the observation group were 40.00%and 14.00%,which were significantly lower than 66.67%and 76.67%in the control group(P<0.05).The incidence of anemia showed no statistically significant difference between the two groups(P>0.05).Conclusion The application of HFNC in the treatment of AECOPD patients with severe pneumonia can reduce the degree of inflammation,promote the recovery of lung function,improve blood gas indicators,and has fewer complications,which is worth promoting in clinical practice.