慢性阻塞性肺疾病急性加重期气管插管拔管后不同呼吸支持方式序贯治疗随机对照研究

Randomized controlled study on sequential treatment of different respiratory support modes after extubation in acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD)急性加重期气管插管拔管后不同呼吸支持方式序贯治疗的临床效果。方法选取2021年1月至2023年3月于九江学院附属医院合并高碳酸血症呼吸衰竭的AECOPD接受有创通气治疗患者48例作为研究对象,符合拔管指征标准下拔管后采用随机数字表法将其分为无创机械通气(NIV)组与经鼻高流量氧疗(HFNC)组,每组各24例。比较两组间拔管前后血气分析指标、平均动脉压、心率、呼吸频率、舒适度、再插管率、气管镜吸痰治疗的情况。结果拔管后6、12、24 h时HFNC组与NIV组间pH、PO_(2)、PCO_(2)和PaO_(2)/FiO_(2)指标比较,差异无统计学意义(P>0.05)。拔管后6、12、24 h时HFNC组与NIV组呼吸频率、心率、平均动脉压比较,差异无统计学意义(P>0.05)。HFNC组舒适度评分高于NIV组,不良事件发生率低于NIV组,差异有统计学意义(P<0.05)。两组间再插管率、所需气管镜吸痰治疗率比较,差异无统计学意义(P>0.05)。结论在接受有创通气的严重高碳酸血症呼吸衰竭的COPD患者中,拔管后使用HFNC并不会导致治疗失败率增加,相比NIV能更好地改善呼吸频率、具有更好的耐受性和舒适度,可作为一种有效的序贯治疗的呼吸支持手段。

Objective To investigate the clinical effect of sequential treatment with different respiratory support after extubation in acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods From January 2021 to March 2023,48 acute exacerbation of COPD(AECOPD)patients with hypercapnia who were treated with invasive ventilation in Affiliated Hospital of Jiujiang University were selected as the study objects,after meeting the criteria for extubation,they were divided into non-invasive mechanical ventilation(NIV)group and high-flow nasal cannula oxygen therapy(HFNC)group according to the random number table method,24 cases in each group.Blood gas analysis indexes,mean arterial pressure,heart rate,respiratory rate,comfort level,reintubation rate and tracheoscopy sputum aspiration were compared between the two groups before and after extubation.Results There were no statistical differences in pH values,PO2,PCO2,and PaO2/FiO2 between HFNC group and NIV groups with in 6,12,24 h after extubation(P>0.05).The respiratory rate,heart rate and mean arterial pressure within 6,12,24 h after extubation in HFNC group and NIV group were not significantly different(P>0.05).The comfort score in HFNC group was higher than that in NIV group,and the total incidence of adverse event was lower than that of NIV group,the difference were statistically significant(P<0.05).The re-intubation rate and required bronchoscopic treatment rate were not statistically different between the two groups(P>0.05).Conclusion Among COPD patients with severe hypercapnic respiratory failure who received invasive ventilation,the use of HFNC after extubation does not result in increased rates of treatment failure compared with NIV.HFNC also has better tolerance and comfort than NIV.