HFNC治疗中不同流速对COPD合并呼吸衰竭患者康复进程的影响

Effect of Different Flow Rates in HFNC Treatment on the Rehabilitation Process of COPD Patients with Respiratory Failure

目的:研究经鼻主流量氧疗(HFNC)治疗中不同流速对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者康复进程的影响。方法:选取2021年10月—2023年10月吉安市第一人民医院收治的COPD合并呼吸衰竭患者147例,采用随机数字表法将患者分为低速组(30 L/min)、中速组(40 L/min)及高速组(50 L/min),各49例。比较三组临床指标(气管插管率、住院时间)、血气分析[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、呼吸频率、呼吸舒适度[数字分级评分法(NRS)]、症状评分及生活质量[COPD评估测试(CAT)、圣乔治呼吸问卷(SGRQ)]。结果:三组气管插管率差异无统计学意义(P>0.05);中速组、高速组的住院时间均短于低速组(P<0.05),中速组、高速组住院时间差异无统计学意义(P>0.05);中速组、高速组治疗后PaO_(2)均高于低速组,PaCO_(2)均低于低速组(P<0.05),中速组、高速组上述指标组间差异均无统计学意义(P>0.05);三组治疗后呼吸频率差异无统计学意义(P>0.05);低速组、中速组治疗后NRS评分均低于高速组(P<0.05),低速组、中速组NRS评分差异无统计学意义(P>0.05);中速组、高速组治疗后CAT评分、SGRQ评分均低于低速组(P<0.05),中速组、高速组上述评分差异均无统计学意义(P>0.05)。结论:COPD合并呼吸衰竭患者采用HFNC治疗中设置流速为40 L/min既可以显著改善血气分析指标、加快恢复、改善运动耐力及生活质量,又可以保证患者治疗的舒适度。

Objective:To investigate the effects of different flow rates of high flow nasal cannula(HFNC)on the rehabilitation process of patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Method:A total of 147 patients with COPD complicated with respiratory failure admitted to Ji’an First People's Hospital from October 2021 to October 2023 were selected and randomly divided into low-speed group(30 L/min),medium-speed group(40 L/min)and high-speed group(50 L/min),with 49 cases in each group.Clinical indicators(tracheal intubation rate,length of hospital stay),blood gas analysis[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],respiratory rate,respiratory comfort[numerical rating scale(NRS)],symptom score and quality of life[COPD assessment test(CAT),St George's respiratory questionnaire(SGRQ)]were compared among the three groups.Result:There was no significant difference in tracheal intubation rate among the three groups(P>0.05).The length of hospital stay in the medium-speed group and the high-speed group were shorter than that in the low-speed group(P<0.05),but there was no statistical significance between the medium-speed group and the high-speed group(P>0.05).After treatment,PaO_(2) and PaCO_(2) in the medium-speed group and high-speed group were higher than those in the low-speed group(P<0.05),and there were no statistical significance between the medium-speed group and high-speed group(P>0.05).There was no significant difference in respiratory rate among the three groups after treatment(P>0.05).After treatment,NRS scores in low-speed group and medium-speed group were lower than that in high-speed group(P<0.05),but there was no significant difference in NRS score between low-speed group and medium-speed group(P>0.05).After treatment,CAT scores and SGRQ scores in medium-speed group and high-speed group were lower than those in low-speed group(P<0.05),and there were no statistical significance between medium-speed group and high-speed group(P>0.05).Conclusion:In the treatment of COPD patients with respiratory failure,HFNC at a flow rate of 40 L/min can not only significantly improve blood gas analysis indicators,accelerate recovery,improve exercise endurance and quality of life,but also ensure the comfort of patients.