以肺部感染控制窗为切点经鼻高流量氧疗在COPD并呼吸衰竭有创通气序贯治疗中的效果

Effect of High-flow Nasal Cannula with Pulmonary Infection Control Window as Cut-off Point in COPD Complicated with Respiratory Failure for Invasive Ventilation Sequential Treatment

目的:分析慢性阻塞性肺疾病(COPD)并呼吸衰竭患者有创通气后以肺部感染控制(PIC)窗为切点给予经鼻高流量氧疗(HFNC)的效果。方法:选择2018年1月-2020年12月于无锡市锡山人民医院住院治疗的COPD并呼吸衰竭患者80例,采用随机数字表法将患者分为HFNC组及无创通气(NIV)组,各40例。所有患者均进行有创通气治疗,PIC窗出现后,HFNC组给予经鼻高流量氧疗,NIV组给予无创通气。比较两组患者治疗失败率、不良事件发生情况、治疗舒适度、总住院时间及ICU住院时间;比较两组患者拔管前(T_(0))和拔管后1 h(T_(1))、24 h(T_(2))、48 h(T_(3))生命体征及血气分析结果,包括心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、动脉血二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))。结果:两组治疗失败率、总住院时间及ICU住院时间比较,差异均无统计学意义(P>0.05);两组拔管前后不同时间HR、RR、MAP、PaCO_(2)、PaO_(2)/FiO_(2)比较,差异均无统计学意义(P>0.05),两组T_(1)时RR均高于T_(0)时(P<0.05);HFNC组不良事件发生率低于NIV组,舒适度评分高于NIV组,差异均有统计学意义(P<0.05)。结论:对于COPD并呼吸衰竭的有创通气患者,以PIC窗为切点更换为HFNC对患者生命体征及血气指标的影响与NIV相似,但患者不良事件少,舒适度高。

Objective:To analyze the effect of high-flow nasal cannula(HFNC)in patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure after invasive ventilation with pulmonary infection control(PIC)window as the cut-off point.Method:A total of 80 patients with COPD complicated with respiratory failure hospitalized in Wuxi Xishan People’s Hospital from January 2018 to December 2020 were selected,the patients were random number table method divided into HFNC group and non-invasive ventilation(NIV)group,with 40 cases in each group.All patients were treated with invasive ventilation.After PIC window appeared,HFNC group was treated with high-flow nasal cannula oxygen therapy and NIV group was treated with non-invasive ventilation.The treatment failure rate,adverse events,treatment comfort,total length of stay and ICU length of stay were compared between the two groups.The results of vital signs and blood gas analysis before extubation(T_(0))and 1 h(T_(1)),24 h(T_(2))and 48 h(T_(3))after extubation were compared between the two groups,including heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),arterial partial pressure of carbon dioxide(PaCO_(2))and oxygenation index(PaO_(2)/FiO_(2)).Result:There were no significant differences in treatment failure rate,total length of stay and ICU length of stay between the two groups(P>0.05).There were no significant differences in HR,RR,MAP,PaCO_(2) and PaO_(2)/FiO_(2) between the two groups at different times before and after extubation(P>0.05).The RR of the two groups at T_(1) were higher than those at T_(0)(P<0.05).The incidence of adverse events in HFNC group was lower than that in NIV group,and the comfort score was higher than that in NIV group,the differences were statistically significant(P<0.05).Conclusion:For invasive ventilation patients with COPD complicated with respiratory failure,changing to HFNC with PIC window as the cut-off point has similar effect on vital signs and blood gas indexes as NIV,but patients have less adverse events and high comfort.