慢性阻塞性肺疾病患者有创通气拔管后经鼻高流量氧疗-无创正压通气序贯治疗的临床疗效观察

Clinical observation of sequential therapy of nasal high-flow oxygen therapy and noninvasive positive pressure ventilation after extubation in patients with chronic obstructive pulmonary disease

目的研究经鼻高流量氧疗(HFNC)-无创正压通气(NIPPV)序贯疗法在慢性阻塞性肺疾病(COPD)患者有创通气拔管后治疗中的效果。方法以回顾性分析为法,观察对象为2020年1月至2022年1月入院的130例有创通气拔管后的COPD患者,按照治疗方式不同分为研究组(65例)与对照组(65例),研究组行HFNC-NIPPV序贯治疗,对照组行NIPPV治疗。比较两组患者治疗前后舒适度评分、痰液黏稠度、动脉血气指标[动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))]水平与治疗后再插管率、重症监护室(ICU)停留时间、不良反应(腹胀、口咽部干燥、面部损伤)发生率。结果治疗前,两组患者的舒适度评分、痰液黏稠度、动脉血气指标水平差异均无统计学意义(P>0.05);治疗后,两组患者的舒适度评分与PaO_(2)均较治疗前明显升高,痰液黏稠度与PaCO_(2)均较治疗前明显下降,差异均有统计学意义(P<0.05);研究组治疗后舒适度评分与PaO_(2)均明显高于对照组,痰液黏稠度、PaCO_(2)、再插管率、不良反应发生率明显低于对照组,ICU停留时间明显短于对照组,差异均有统计学意义(P<0.05)。结论COPD患者有创通气拔管后HFNC-NIPPV序贯治疗效果显著,可有效提升患者舒适度,降低痰液黏稠度、再插管率及不良反应发生率,还可改善其动脉血气指标水平,促使其快速康复。

Objective To study the effect of sequential therapy of nasal high-flow oxygen therapy(HFNC)-noninvasive positive pressure ventilation(NIPPV)in patients with chronic obstructive pulmonary disease(COPD)after extubation by invasive ventilation.Methods With the method of retrospective analysis,130 COPD patients admitted to hospital from January 2020 to January 2022 were observed.According to the treatment methods,they were divided into study group(65 cases)and control group(65 cases).The study group received HFNC-NIPPV sequential treatment,while the control group received NIPPV treatment.The comfort score,sputum viscosity,arterial blood gas index[arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2))]before and after treatment,the rate of re-intubation,the length of stay in intensive care unit(ICU)and the incidence of adverse reactions(abdominal distension,oropharyngeal dryness,facial injury)were compared between the two groups.Results Before treatment,there were no statistically significant differences in comfort score,sputum viscosity and arterial blood gas index levels between the two groups(P>0.05).After treatment,the comfort score and PaO_(2)of the two groups were increased compared with those before treatment,and the sputum viscosity and PaCO_(2)were decreased compared with those before treatment,and the differences were significant(P<0.05).The comfort score and PaO_(2)in the study group were higher than those in the control group,the sputum viscosity,PaCO_(2),reintubation rate and incidence of adverse reactions were lower than those in the control group,and the ICU stay time was shorter than that in the control group,with significant differences(P<0.05).Conclusion The sequential treatment of HFNC-NIPPV after extubation with invasive ventilation is effective,which can effectively improve the patient's comfort,reduce the sputum viscosity,the rate of re-intubation and the incidence of adverse reactions,and also improve the level of arterial blood gas index,and promote their rapid recovery.