经鼻高流量氧气湿化联合布地奈德福莫特罗对老年AECOPD合并Ⅱ型呼吸衰竭临床预后的影响

Effect of nasal high-flow oxygen humidification combined with budesonide formoterol on clinical prognosis of elderly patients with AECOPD complicated with typeⅡrespiratory failure

目的分析经鼻高流量氧气湿化联合布地奈德福莫特罗对老年慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭临床预后的影响。方法本研究为前瞻性研究。采用随机抽样法,选取西宁市第二人民医院2019年1月至2021年1月收治的110例老年AECOPD合并Ⅱ型呼吸衰竭患者,使用随机数字表法分为联合组、对照组,每组55例,2组均给予常规综合治疗及布地奈德福莫特罗吸入治疗,联合组加用经鼻高流量氧气湿化治疗。对比2组患者治疗前后血气分析指标、生命体征指标、实验室指标变化,并比较2组治疗转归。结果治疗1 d后,2组患者血氧饱和度、动脉血氧分压、氧合指数、pH值均较治疗前升高,动脉血二氧化碳分压、呼吸频率、心率、内皮素1、中性粒细胞/淋巴细胞比值、白细胞介素6、肿瘤坏死因子α均较治疗前下降,联合组变化较对照组更为显著,差异有统计学意义(P值均<0.05)。联合组气管插管率、住院时间低于对照组[5.45%比23.64%,χ^(2)=7.31;(22.15±4.61)d比(26.48±5.29)d,t=4.58,P值均<0.05]。联合组和对照组患者治疗期间并发症发生率比较,差异无统计学意义(10.91%比9.09%,χ^(2)=0.10,P>0.05)。治疗7 d时,联合组总有效率为94.55%(52/55),高于对照组(78.18%,43/55),差异有统计学意义(χ^(2)=6.25,P<0.05)。结论在常规综合治疗及布地奈德福莫特罗吸入治疗的基础上,给予经鼻高流量氧气湿化治疗能够进一步改善老年AECOPD合并Ⅱ型呼吸衰竭患者血气指标、生命体征、炎症状态及内皮功能,对于提高患者转归及疗效,进而改善患者临床预后也有着积极意义。

Objective To analyze the effect of nasal high-flow oxygen humidification combined with budesonide formoterol on the clinical prognosis of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with typeⅡrespiratory failure.Methods This was a prospective study.A random sampling method was used.From January 2019 to January 2021 in Xining Second People′s Hospital,110 elderly patients with AECOPD complicated with typeⅡrespiratory failure were selected and randomly divided into the combined group and the control group,with 55 cases in each group.Both groups were given conventional comprehensive treatment and budesonide formoterol inhalation therapy,while the combined group was additionally given nasal high-flow oxygen humidification therapy.Blood gas analysis indexes,vital signs indexes,and laboratory indexes of the two groups before and after treatment were compared,and the treatment outcomes of the two groups were also compared.Results After 1 day of treatment,the blood oxygen saturation,arterial partial pressure of oxygen,oxygenation index,and pH value of patients in both groups increased compared with those before treatment.PaCO2,RR,HR,ET-1,NLR,IL-6,and TNF-αwere lower than those before treatment.The changes in the combined group were more significant,with statistical significance(P<0.05).The tracheal intubation rate and hospital stay in the combined group were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups during treatment(P>0.05).After 7 days of treatment,the total effective rate of the combined group was 94.55%,which was higher than that of the control group(78.18%),and the difference was statistically significant(P<0.05).Conclusions On the basis of routine comprehensive treatment and budesonide formoterol inhalation therapy,nasal high-flow oxygen humidification therapy can further improve the blood gas index,vital signs,inflammatory state,and endothelial function of elderly patients with AECOPD complicated with typeⅡrespiratory failure.The combined treatment also has significance in improving the outcome and curative effect,further improving the clinical prognosis of patients.