经鼻高流量湿化氧疗对慢性阻塞性肺疾病患者机械通气拔管后神经通气驱动和呼吸做功影响的临床研究

Clinical study on the effect of high-flow nasal cannula oxygen therapy on nerve ventilation drive and respiratory work in patients with chronic obstructive pulmonary disease after mechanical ventilation extubation

目的探究经鼻高流量湿化氧疗(HFNC)对慢性阻塞性肺疾病(COPD)患者机械通气拔管后神经通气驱动和呼吸做功的影响。方法选取2020年1月至2022年6月在浙江省衢州市人民医院重症监护病房(ICU)和急诊重症监护病房进行机械通气治疗并拔管的292例COPD患者,随机分为观察组和对照组,每组146例。观察组患者接受HFNC干预,对照组患者接受文丘里面罩氧疗干预。比较2组患者一般资料;比较2组患者氧疗开始时及氧疗30 min、60 min、24 h呼吸参数、血气分析指标、膈肌电活动(EAdi)数据和吸气努力指数;比较2组患者的临床指标差异。结果研究期间对照组和观察组分别有7例、5例患者被剔除。氧疗60 min后和氧疗24 h后观察组呼吸频率、动脉血二氧化碳分压低于对照组,氧合指数、动脉血氧分压高于对照组,差异均有统计学意义(均P<0.05)。氧疗60 min后和氧疗24 h后观察组EAdi峰值、EAdi谷值、EAdi曲线下面积、跨膈压压力-时间乘积、每分钟跨膈压压力-时间乘积和每吸跨膈压压力-时间乘积均低于对照组,差异均有统计学意义(均P<0.05)。观察组患者的48 h内再插管率、ICU住院费用和ICU住院时间均低于/短于对照组[6.4%(9/141)比18.7%(26/139),(4.3±0.8)万元比(6.1±1.1)万元,(5.7±1.1)d比(7.8±1.3)d],差异均有统计学意义(均P<0.05)。结论与传统氧疗方法相比,HFNC可有效改善COPD患者机械通气拔管后神经通气驱动和呼吸做功,降低再插管率,且缩短ICU住院时间,减少治疗费用。

Objective To explore the effects of high-flow nasal cannula oxygen therapy(HFNC)on nerve ventilation drive and respiratory work in patients with chronic obstructive pulmonary disease(COPD)after mechanical ventilation extubation.Methods A total of 292 COPD patients who underwent mechanical ventilation and extubation in the Intensive Care Unit(ICU)and the Emergency Intensine Care Unit of People′s Hospital of Quzhou,Zhejiang Province from January 2020 to June 2022 were selected and randomly divided into observation group and control group,with 146 cases in each group.The observation group received HFNC intervention,and the control group received Venturi mask oxygen therapy intervention.The general data of the two groups were compared.The respiratory parameters,blood gas analysis indexes,diaphragm electrical activity(EAdi)data and inspiratory effort index were compared between the two groups at the beginning of oxygen therapy and 30 min,60 min,24 h of oxygen therapy.The differences of clinical indicators between the two groups were compared.Results During the study period,7 and 5 patients were excluded from the control group and the observation group.After 60 min of oxygen therapy and 24 h of oxygen therapy,the respiratory rate and arterial partial pressure of carbon dioxide in the observation group were lower than those in the control group,and the oxygenation index and arterial oxygen partial pressure were higher than those in the control group(all P<0.05).After 60 min of oxygen therapy and 24 h of oxygen therapy,the EAdi peak value,the EAdi valley value,the area under the EAdi curve,the product of diaphragmatic pressure-time,the product of diaphragmatic pressure-time per minute,and the product of diaphragmatic pressure-time per aspiration in the observation group were lower than those in the control group(all P<0.05).The reintubation rate within 48 h,ICU hospitalization cost and ICU hospitalization time in the observation group were lower/shorter than those in the control group[6.4%(9/141)vs 18.7%(26/139),(43±8)thousand yuan vs(61±11)thousand yuan,(5.7±1.1)d vs(7.8±1.3)d](all P<0.05).Conclusion Compared with traditional oxygen therapy,HFNC can effectively improve the neural ventilation drive and respiratory work of COPD patients after mechanical ventilation extubation,reduce the reintubation rate,shorten the length of ICU stay,and reduce the treatment cost.