经鼻高流量湿化氧疗对支气管扩张急性加重并Ⅱ型呼吸衰竭患者血气分析和肺功能的影响

Effect of high-flow nasal cannula oxygen therapy on blood gas analysis and pulmonary function in patients with acute exacerbation of bronchiectasis and typeⅡrespiratory failure

目的探讨经鼻高流量湿化氧疗(HFNC)联合常规治疗对支气管扩张急性加重并Ⅱ型呼吸衰竭患者血气分析和肺功能的影响。方法选取2020年7月至2023年1月广西壮族自治区民族医院呼吸与危重症医学科收治的40例支气管扩张急性加重并Ⅱ型呼吸衰竭患者作为研究对象,按照随机数字表法分为传统氧疗组(20例)和HFNC组(20例)。传统氧疗组采用鼻导管吸氧治疗,HFNC组采用HFNC治疗。比较两组患者治疗前和治疗后2、24 h、出院前动脉血气分析指标[动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))和氧合指数(PaO_(2)/FiO_(2))]的变化。比较两组治疗前后肺功能指标[第一秒用力呼气容积(FEV_(1))、第一秒用力呼气容积占预计值百分比(FEV_(1)%)、用力肺活量(FVC)、第一秒用力呼气容积与用力肺活量的比值(FEV_(1)/FVC)]和改良版英国医学研究委员会(mMRC)呼吸困难问卷评分的变化。结果治疗后2、24 h和出院前,两组的PaO_(2)、PaO_(2)/FiO_(2)均高于本组治疗前,且HFNC组的PaO_(2)、PaO_(2)/FiO_(2)高于传统氧疗组,差异有统计学意义(P<0.05)。治疗后24 h和出院前,传统氧疗组的PaCO_(2)低于本组治疗前,差异有统计学意义(P<0.05)。治疗后2、24 h和出院前,HFNC组的PaCO_(2)低于本组治疗前,且HFNC组的PaCO_(2)低于传统氧疗组(P<0.05)。出院前,两组的FEV_(1)、FEV_(1)%、FVC和FEV_(1)/FVC均高于本组治疗前,且HFNC组的FEV_(1)、FEV_(1)%、FVC和FEV_(1)/FVC高于传统氧疗组,差异有统计学意义(P<0.05)。出院前,两组的mMRC评分均低于本组治疗前,且HFNC组mMRC评分低于传统氧疗组,差异有统计学意义(P<0.05)。结论HFNC用于治疗支气管扩张急性加重并Ⅱ型呼吸衰竭患者,其疗效较好。较之传统氧疗,HFNC能更快、更好地改善患者血气分析指标和肺功能指标,更好地减轻患者呼吸困难症状。

Objective To explore the effect of high-flow nasal cannula oxygen therapy(HFNC)combined with conventional therapy on blood gas analysis and pulmonary function in patients with acute exacerbation of bronchiectasis and typeⅡrespiratory failure.Methods A total of 40 patients with acute exacerbation of bronchiectasis and typeⅡrespiratory failure admitted to the Department of Respiratory and Critical Care Medicine,Guangxi Zhuang Autonomous Region National Hospital from July 2020 to January 2023 were selected as the study objects,and they were divided into traditional oxygen therapy group(20 cases)and HFNC group(20 cases)according to random number table method.The traditional oxygen therapy group was treated with nasal catheter,and the HFNC group was treated with HFNC.The changes of arterial blood gas analysis indexes(arterial partial pressure of oxygen[PaO_(2)],arterial partial pressure of carbon dioxide[PaCO_(2)]and Oxygenation index[PaO_(2)/FiO_(2)])were compared in the two groups before treatment,2 and 24 hours after treatment and before discharge.The changes of pulmonary function indexes(forced expiratory volume in one second[FEV_(1)],the percentage of forced expiratory volume in one second[FEV_(1)%],forced vital capacity[FVC],forced expiratory volume in one second/forced vital capacity[FEV_(1)/FVC])and modified British Medical Research Council(mMRC)dyspnea questionnaire scores before and after treatment were compared in the two groups.Results At 2 hours,24 hours after treatment and before discharge,the PaO_(2)and PaO_(2)/FiO_(2)of two groups were higher than those before treatment in the same group,and the PaO_(2)and PaO_(2)/FiO_(2)in the HFNC group were higher than those in the traditional oxygen therapy group,and the differences were statistically significant(P<0.05).At 24 hours after treatment and before discharge,the PaCO_(2)of the traditional oxygen therapy group was lower than that before treatment of the same group,and the difference was statistically significant(P<0.05).At 2 hours,24 hours and before discharge,the PaCO_(2)of HFNC group was lower than that before treatment in the same group,and the PaCO_(2)in the HFNC group was lower than that in the traditional oxygen therapy group,and the differences were statistically significant(P<0.05).Before discharge,the FEV_(1),FEV_(1)%,FVC,and FEV_(1)/FVC in two groups were higher than those before treatment in the same group,and the FEV_(1),FEV_(1)%,FVC,and FEV_(1)/FVC in the HFNC group were higher than those in the traditional oxygen therapy group,and the differences were statistically significant(P<0.05).Before discharge,the mMRC scores of two groups were lower than those before treatment in the same group,and the mMRC score in the HFNC group was lower than that in the traditional oxygen therapy group,and the differences were statistically significant(P<0.05).Conclusion HFNC is effective in the treatment of patients with acute exacerbation of bronchiectasis and typeⅡrespiratory failure.Compared with traditional oxygen therapy,HFNC can improve the blood gas analysis index and lung function index of patients faster and better,and alleviate the symptoms of dyspnea.