无创正压通气与经鼻高流量氧疗治疗慢性阻塞性肺疾病急性加重期轻度呼吸衰竭患者的疗效观察

Observation on the efficacy of non-invasive positive pressure ventilation and high-flow nasal oxygen therapy in the treatment of mild respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者应用无创正压通气(NIPPV)及经鼻高流量氧疗(HFNC)的临床疗效。方法2020年1月至2022年1月我院收治的AECOPD患者112例,按照随机数字表法分为对照组和观察组各56例。在常规治疗基础上,对照组采用NIPPV治疗,观察组采用HFNC治疗。比较两组治疗前、治疗1周后血钾、血钠、肺通气、炎症相关因子水平、呼吸困难评分量表(DECAF)评分的变化及气管插管率情况。结果治疗1周后,观察组血钾水平均高于对照组,呼吸道总阻力(R5)、中心呼吸道阻力(R20)、周边呼吸道阻力(R5-R20)、降钙素原(PCT)、细胞介素-17(IL-17)、可溶性髓系细胞表达的触发受体-1(sTREM-1)水平、DECAF评分均低于对照组(P<0.05)。观察组气管插管率显著低于对照组(P<0.05)。结论与NIPPV治疗相比,HFNC能有效改善AECOPD患者肺通气功能,显著降低炎症相关因子水平,是一种安全性高、疗效确切的通气方式。

Objective To investigate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)and high-flow nasal cannula oxygen therapy(HFNC)in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods One hundred and twelve patients with AECOPD admitted to our hospital from January 2020 to January 2022 were selected.The patients were divided into a control group and an observation group by using random number table method,56 in each group.Under the basis of conventional treatment,the control group was treated with NIPPV while the observation group was treated with HFNC.The levels of serum potassium,serum sodium,pulmonary ventilation and inflammation-related factors as well as scores of dyspnea,eosinopenia,consolidation,acidemia and atrial fibrillation(DECAF)before and after 1 week of treatment were compared between the two groups.The tracheal intubation rate during treatment was also compared.Results After 1 week of treatment,the levels of serum potassium in the observation group were obviously higher than those in the control group(P<0.05).Total airway resistance(R5),central airway resistance(R20),peripheral airway resistance(R5-R20),levels of procalcitonin(PCT),interleukin-17(IL-17),and soluble myeloid cell expression triggering receptors Body-1(sTREM-1)and DECAF scores in the observation group were lower than those in the control group(allP<0.05).The rate of tracheal intubation during treatment was significantly lower in the observation group compared to the control group(P<0.05).Conclusions Compared with NIPPV in the treatment of patients with AECOPD,HFNC can improve the pulmonary ventilation function more effectively.It also significantly reduces the levels of inflammation-related factors.Thus,HFNC is a ventilation method with high safety and exact efficacy.