经鼻高流量湿化氧疗在慢性阻塞性肺疾病急性加重期患者的应用价值

Application of high-flow nasal cannula oxygen therapy in patients with acute exacerbations of chronic obstructive pulmonary disease

目的探讨经鼻高流量湿化氧疗(HFNC)对慢性阻塞性肺疾病急性加重期(AECOPD)患者的疗效及适用条件。方法回顾性分析中山市小榄人民医院呼吸内科2021年1月~2022年12月收治并好转出院的60例AECOPD患者的临床资料,所有患者均在抗感染、止咳化痰、平喘等治疗的基础上,给予呼吸支持治疗。按照呼吸支持治疗方式不同分为HFNC组(30例)与无创正压通气(NPPV)组(30例)。比较两组患者生命体征(心率、呼吸)、血气分析[氧分压(PaO_(2))、氧合指数(PaO_(2)FiO_(2))]情况。根据年龄及PaO_(2)FiO_(2)分层,分析HFNC组患者血气分析指标的变化情况。结果治疗前,两组患者心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)组间比较,差异无统计学意义(P>0.05)。治疗后,两组患者心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)组间比较,差异无统计学意义(P>0.05);HFNC组治疗前后心率、PaO_(2)、PaO_(2)FiO_(2)比较[(85.47±13.21)次min vs.(97.67±22.62)次min、(95.92±27.33)mmHg vs.(80.3±19.02)mmHg、(321.23±78.73)mmHg vs.(278.40±67.21)mmHg],差异有统计学意义(P<0.05);NPPV组治疗前后心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)比较[(90.33±12.02)次min vs.(105.70±22.03)次min、(20.67±0.76)次min vs.(24.93±2.45)次min、(91.54±34.81)mmHg vs.(70.86±24.03)mmHg、(311.03±113.14)mmHg vs.(240.53±86.28)mmHg],差异有统计学意义(P<0.05)。根据年龄及PaO_(2)FiO_(2)分层,与治疗前比较,HFNC组患者年龄≥71岁、PaO_(2)FiO_(2)在201~300 mmHg之间的患者治疗后PaO_(2)、PaO_(2)FiO_(2)明显上升,差异有统计学意义(P<0.05)。结论HFNC及NPPV均可改善AECOPD患者的氧合功能,效果相当,可作为NPPV的备选方案。HFNC尤其适用于年龄71岁及以上、PaO_(2)FiO_(2)在201~300 mmHg的人群。

Objective To explore the value of HFNC in patients with AECOPD.Methods A retrospective analysis was conducted on the clinical data of 66 AECOPD patients admitted and discharged from the respiratory department of Xiaolan People′s Hospital from January 2021 to December 2022.All patients received respiratory support treatment on the basis of anti infection,cough relieving,phlegm resolving,and asthma relieving treatments.According to different respiratory support treatment method,they were divided into HFNC group(30 cases)and NPPV group(30 cases).Compare the vital signs,blood gas analysis of two groups of patients.The changes in blood gas analysis indicators of patients in the HFNC group were stratified based on age and oxygenation index.Results There was no statistically significant difference in heart rate,respiratory frequency,oxygen partial pressure,and oxygenation index between the two groups before treatment(P>0.05).There was no statistically significant difference in heart rate,respiratory frequency,oxygen partial pressure,and oxygenation index between the two groups after treatment(P>0.05).In the HFNC group,there was a statistically significant difference in heart rate,oxygen partial pressure,and oxygenation index before and after treatment(P<0.05);The NPPV group showed statistically significant differences in heart rate,respiratory frequency,oxygen partial pressure,and oxygenation index before and after treatment(P<0.05).Patients in the HFNC group were stratified based on age and oxygenation index.Compared with before treatment,patients aged 71 years and above with oxygenation index between 201~300 mmHg showed a significant increase in PaO_(2)and PaO_(2)FiO_(2)after treatment,with a statistically significant difference(P<0.05).Conclusion Both HFNC and NPPV can improve oxygenation function in AECOPD patients,with comparable effects and can be used as alternative options for NPPV.HFNC is particularly suitable for people aged 71 years and above,with PaO_(2)FiO_(2)between 201~300 mmHg.