经鼻高流量吸氧联合常规综合干预对COPD合并Ⅱ型呼吸衰竭患者血气水平的调节机制研究

Study on the regulatory mechanism of nasal high-flow oxygen inhalation combined with comprehensive intervention on blood gas levels in patients with chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure

目的探讨经鼻高流量吸氧联合综合干预对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并Ⅱ型呼吸衰竭患者血气水平的调节机制。方法选取2018年5月至2021年5月临海市第二人民医院医共体收治的100例COPD合并Ⅱ型呼吸衰竭患者为研究对象,采用随机数字表法分为对照组和观察组,每组各50例。对照组采用常规治疗联合综合干预,观察组在对照组基础上采用经鼻高流量吸氧,治疗后对比两组患者的临床疗效、治疗前后的血气分析指标、生理指标。结果观察组临床总有效率(96.0%)高于对照组(80.0%),差异有统计学意义(χ^(2)=6.061,P<0.05)。治疗后两组患者的动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))、pH值较治疗前升高,且观察组高于对照组;两组患者的二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))水平均降低,且观察组低于对照组(P<0.05)。治疗后两组患者的血氧饱和度(oxygen saturation,SaO_(2))水平较治疗前升高,且观察组高于对照组;两组患者的呼吸频率(respiratory rate,RR)及心率(heart rate,HR)均降低,且观察组低于对照组(P<0.05)。对照组与观察组患者治疗后的氧合指数[PaO_(2)/吸入气中的氧浓度分数(fraction of inspination O_(2),FiO_(2))]分别为(214±21)、(274±27)mmHg,治疗后两组的PaO_(2)/FiO_(2)均升高,且观察组患者治疗后的PaO_(2)/FiO_(2)明显高于对照组(P<0.05)。结论经鼻高流量吸氧联合综合干预应用于COPD合并Ⅱ型呼吸衰竭患者能有效改善机体缺氧状态,稳定血气及各项生理指标,提高临床疗效。

Objective To investigate the regulatory mechanism of comprehensive intervention combined with nasal high-flow oxygen absorption on blood gas index in patients with COPD combined typeⅡrespiratory failure.Methods A total of 100 patients with COPD combined with typeⅡrespiratory failure who were admitted to Medical Community of Linhai Second People's Hospital from May 2018 to May 2021 were selected as the research objects,and were divided into the control group and the observation group by random number table method,with 50 cases in each group.The control group was combined with comprehensive intervention,and the observation group used trannasal high flow oxygen absorption based on the control group.After treatment,the clinical efficacy of the two groups was compared,including blood gas analysis indicators,physiological indicators.Results The effective rate(96.0%)of patients in the observation group was significantly higher than that of the control group(80.0%),the difference was significant(χ^(2)=6.061,P<0.05).After treatment,the PaO_(2) level and pH value of patients in the two groups were higher than those before treatment,and the observation group was higher than that of the control group;PaCO_(2) in the two groups decreased,and the level of PaCO_(2) in the observation group was lower than that in the control group(P<0.05).After treatment,the level of SaO_(2) in the two groups was higher than that before treatment,and the level of SaO_(2) in the observation group was higher than that in the control group;RR and HR of patients in both groups decreased,and the observation group was lower than the control group(P<0.05).PaO_(2)/FiO_(2) of patients in the control group and the observation group after treatment were(214±21)and(274±27)mmHg respectively after treatment.PaO_(2)/FiO_(2) of patients in the observation group after treatment was significantly higher than that in the control group(P<0.05).Conclusion Comprehensive intervention of high nasal oxygen absorption in patients with COPD can effectively improve hypoxia,stabilize blood gas and physiological indexes and enhance clinical efficacy.