经鼻高流量氧疗与无创正压通气治疗慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭的价值

Value of nasal high-flow oxygen therapy and non-invasive positive pressure ventilation in treating acute exacerbation of chronic obstructive pulmonary disease complicated with typeⅡrespiratory failure

目的探究经鼻高流量氧疗(HFNC)与无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭的价值。方法本研究为病例对照研究,采用完全随机抽样的方法选择2020年5月2022年6月武威市人民医院收治的92例AECOPD合并Ⅱ型呼吸衰竭患者为本次研究对象。采用随机数字表法分为观察组及对照组各46例,观察组用HFNC治疗,对照组用NPPV治疗。比较2组血气分析指标、生命体征、治疗效果和安全用性。结果2组动脉血氧分压(PaO_(2))、pH值均较治疗前升高,动脉血二氧化碳分压(PaCO_(2))较治疗前降低(P<0.05),治疗后2组PaO_(2)、pH值和PaCO_(2)差异无统计学意义(均P>0.05),观察组PaO_(2)(56.85±5.51)mmHg(1 mmHg=0.133 kPa)比(64.11±7.52)mmHg、pH值(7.25±0.21)比(7.37±0.16)、PaCO_(2)(68.11±5.26)mmHg比(55.55±5.29)mmHg;对照组PaO_(2)(57.21±5.32)mmHg比(66.25±7.11)mmHg、pH值(7.26±0.25)比(7.36±0.14)、PaCO_(2)(67.98±5.42)mmHg比(54.59±5.69)mmHg;2组治疗后的呼吸频率、心率均较治疗前降低(均P<0.05),平均动脉压均较治疗前升高(均P<0.05),治疗后组间呼吸频率、心率和平均动脉压比较差异无统计学意义(P>0.05);观察组呼吸困难缓解时间(8.06±1.12)d长于对照组(6.51±1.02)d,观察组呼吸支持时间(8.69±1.20)d长于对照组(7.15±1.11)d,差异均有统计学意义(均P<0.05);2组治疗有效率、住院时间比较差异均无统计学意义(均P>0.05);观察组不良事件发生率6.52%(3/46)低于对照组39.13%(18/46),差异有统计学意义(P<0.05)。结论HFNC、NPPV对于AECOPD合并Ⅱ型呼吸衰竭的治疗效果相似,相比于HFNC治疗,NPPV可缩短呼吸困难缓解及呼吸支持时间,但HFNC治疗可提升治疗安全性,降低并发症率。

Objective To investigate the value of nasal high-flow oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NPPV)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with typeⅡrespiratory failure.Methods This was a case-control study.A total of 92 patients with AECOPD combined with typeⅡrespiratory failure admitted to Wuwei People′s Hospital from May 2020 to June 2022 were selected as the study subjects.Using complete random sampling method,the patients were divided into observation group(n=46)and control group(n=46),with the former treated with HFNC and the latter with NPPV.The blood gas analysis indexes,vital signs,therapeutic effect,and safety of the two groups were compared.Results After treatment,the arterial oxygen partial pressure(PaO_(2))and pH value in both groups were higher than those before treatment(observation group:PaO_(2)[64.11±7.52]mmHg vs[56.85±5.51]mmHg,pH value[7.37±0.16]vs[7.25±0.21];control group:PaO_(2)[66.25±7.11]mmHg vs[57.21±5.32]mmHg,pH value[7.36±0.14]vs[7.26±0.25]);and the arterial partial pressure of carbon dioxide(PaCO_(2))was lower than that before treatment(observation group:[55.55±5.29]mmHg vs[68.11±5.26]mmHg;control group:[54.59±5.69]mmHg vs[67.98±5.42]mmHg)(P<0.05).There was no significant difference in PaO_(2),pH,and PaCO_(2)between the two groups after treatment(P>0.05).After treatment,the respiratory rate and heart rate of the two groups were lower than those before treatment(P<0.05),and the average arterial pressure of the two groups was higher than those before treatment(P<0.05).There was no significant difference in respiratory rate,heart rate,and mean arterial pressure between the two groups after treatment(P>0.05).The dyspnea relief time and respiratory support time of the observation group were longer than those of the control group([8.06±1.12]d vs[6.51±1.02]d and[8.69±1.20]d vs[7.15±1.11]d respectively),with statistical significance(P<0.05).There was no significant difference in effective rate and hospitalization time between the two groups(P>0.05).The incidence of adverse events in observation group was lower than that in control group,with 6.52%(3/46)vs 39.13%(18/46),the difference statistically significant(P<0.05).Conclusions HFNC and NPPV have similar therapeutic effects on AECOPD complicated with typeⅡrespiratory failure.Compared with HFNC,NPPV can shorten the time of dyspnea relief and respiratory support,but HFNC can improve the treatment safety and reduce the complication rate.