高流量氧疗对慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭的疗效分析

Effect of high flow oxygen therapy on chronic obstructive pulmonary disease with type Ⅱ respiratory failure

目的 探讨经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)应用于慢性阻塞性肺疾病急性发作(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)伴轻中度Ⅱ型呼吸衰竭患者的疗效。方法 通过回顾性评价2019年1月1日-2022年6月30日期间南京医科大学第一附属医院及南京市高淳人民医院156例AECOPD伴轻中度Ⅱ型呼吸衰竭患者使用不同呼吸支持方式的临床疗效。研究纳入HFNC患者94例,无创辅助通气(non-invasive ventilation,NIV)患者62例。观察两组患者治疗前、治疗后第1天及第7天临床症状、血气分析,比较HFNC及NIV的疗效、并发症发生率,并探讨HFNC应用时机。结果 HFNC组与NIV组治疗后第1天及第7天时pH、PaCO_(2)、氧合指数(PaO_(2)/FiO_(2),P/F)较治疗前明显改善(P<0.05);组间比较,上述各项指标改善率无统计学差异(P>0.05);HFNC组并发症发生率低于NIV组;通过对HFNC组内的pH、PaCO_(2)及联合诊断的效果评价,进行ROC曲线分析发现,pH是AECOPD伴Ⅱ型呼吸衰竭患者应用HFNC的预后判断指标,其临界值为7.318。结论 对于AECOPD伴轻中度Ⅱ型呼吸衰竭患者,HFNC能显著改善pH、PaCO_(2)及P/F,其疗效与NIV相当,不良反应发生率低于NIV;根据ROC曲线分析,pH是AECOPD伴Ⅱ型呼吸衰竭患者应用HFNC重要预后判断指标,pH≥7.318的患者HFNC疗效较好,pH<7.318患者HFNC疗效欠佳。

Objective To investigate the effect of High-flow nasal cannula oxygen therapy(HFNC) in patients with acute chronic obstructive pulmonary disease(AECOPD) complicated with mild to moderate type Ⅱ respiratory failure.Methods 156 patients diagnosed with AECOPD with mild-moderate type Ⅱ respiratory failure(94 patients using HFNC and 62 patients using NIV) in the First Affiliated Hospital of Nanjing Medical University and Gaochun People's Hospital of Nanjing City from January 1,2019 to June 30,2022 were retrospectively analyzed.The efficacy and complication rates of HFNC and NIV were compared by analyzing clinical symptoms and arterial blood gases of patients at the beginning of treatment,one day after treatment,and seven days after treatment.We also discuss the optimal time to use HFNC.Results The pH,PaCO,and oxygenation index(PaO_2/FiO_2,P/F) in the HFNC group and NIV group at 1st and 7 th day after treatment were significantly improved compared with before treatment(P<0.05);There was no significant difference in the improvement rate of the above indexes between groups(P>0.05).The complication rate of the HFNC group was lower than that of the NIV group.Through the evaluation of pH,PaCO_2,and the combined diagnosis effect in the HFNC group,ROC curve analysis showed that pH was the prognostic indicator of HFNC in patients with AECOPD and type Ⅱ respiratory failure,and the critical value was7.318.Conclusion For AECOPD patients with mild to moderate type Ⅱ respiratory failure,HFNC can significantly improve pH,PaCO_2,and P/F,and its efficacy is comparable to that of NIV,and the incidence of adverse reactions is lower than NIV.According to ROC curve analysis,pH is an important prognostic indicator of HFNC in patients with AECOPD and type Ⅱ respiratory failure.Patients with pH≥7.318 have a better effect on HFNC,while patients with pH <7.318 have a poor effect on HFNC.