肺心病并发Ⅱ型呼吸衰竭患者经鼻高流量氧疗的应用价值

APPLICATION VALUE OF TRANSNASAL HYPERFLOW OXYGEN THERAPY IN PATIENTS WITH COR PULMONALE COMPLICATED WITH TYPE Ⅱ RESPIRATORY FAILURE

目的 探讨经鼻高流量氧疗治疗用于肺心病并发Ⅱ型呼吸衰竭患者的临床价值。方法 本研究纳入的对象是廊坊市人民医院2019年3月至2021—4月收治的62例肺心病合并Ⅱ型呼吸衰竭患者,采用随机数字表法分为二组,对照组与观察组各31例。二组患者均行常规对症治疗,在此基础上,对照组加用鼻导管低流量氧疗,观察组加用经鼻高流量氧疗,二组患者均持续治疗10 d。比较二组患者治疗前后肺功能指标[用力肺活量(FVC)、第1秒用力呼气量(FEV1)、第一秒用力呼气量与用力肺活量的比值(FEV1/FVC)]、炎性反应指标[N末端脑钠肽前体(NT-proBNP)、血清C反应蛋白(CRP)]、血气分析指标[动脉血氧分压(PaO_(2))、血液pH值、脉血二氧化碳分压(PaCO_(2))]、血液流变学指标[血浆粘度、全血低切粘度、全血高切粘度、红细胞压积]、凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)]。结果 观察组患者治疗后FEV1、FVC、FEV1/FVC高于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后NT-proBNP、CRP低于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后PaO_(2)、pH值高于对照组;PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后血液流变学指标低于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后PT、TT、APTT高于对照组;FIB低于对照组,差异有统计学意义(P<0.05)。结论 经鼻高流量氧疗治疗肺心病并发Ⅱ型呼吸衰竭患者,能有效改善患者的肺功能、血气、血液流变学、凝血功能,降低机体炎性反应,值得临床借鉴与推广。

Objective Transnasal high flow oxygen therapy is a new non-invasive ventilation method.At present,there are few studies on it in patients with cor pulmonale complicated with type Ⅱ respiratory failure.The efficacy of transnasal high flow oxygen therapy in the treatment of cor pulmonale complicated with type Ⅱ respiratory failure is still lack of experimental and theoretical support.Objective To explore the clinical value of transnasal high flow oxygen therapy in patients with cor pulmonale complicated with type Ⅱ respiratory failure.Methods Sixty-two patients with cor pulmonale complicated with type Ⅱ respiratory failure who were treated in the Langfang people's Hospital from March 2019 to April 2021 were selected as the research objects.The patients were divided into two groups by random number table,with 31 cases in the control group and 31 cases in the observation group.The patients in both groups received routine symptomatic treatment.On this basis,the control group was treated with nasal catheter low flow oxygen therapy,and the observation group was treated with nasal high flow oxygen therapy.The patients in both groups were treated for 10 days.The pulmonary function indexes[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC],inflammatory reaction indexes[N-terminal pro-B type natriuretic peptide(NT-proBNP),C-reactiveprotein(CRP)],blood gas analysis indexes[arterial partial pressure of carbon dioxide(PaCO_(2)),blood pH value,arterial partial pressure of oxygen(PaO_(2))],and hemorheological indexes[plasma viscosity,whole blood low shear viscosity,whole blood high shear viscosity,hematocrit],coagulation function indexes[prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),activated partial thromboplastin time(APTT)].Results The FEV1,FVC and FEV1/FVC in the observation group were significantly higher than in the control group after treatment(P<0.05).The NT-proBNP and CRP in the observation group were lower than in the control group after treatment(P<0.05).The PaO_(2) and pH values in the observation group were higher than in the control group after treatment;PaCO_(2) was significantly lower than in the control group(P<0.05).The hemorheological indexes in the observation group were lower than in the control group after treatment(P<0.05).The PT,TT and APTT in the observation group were higher than in the control group after treatment;FIB was significantly lower than in the control group(P<0.05).Conclusion Nasal high flow oxygen therapy can effectively improve the pulmonary function,blood gas,hemorheology and coagulation function of patients with cor pulmonale complicated with type II respiratory failure,and reduce the inflammatory reaction of the body,which is worthy of clinical reference and promotion.