加温加湿经鼻高流量氧疗对难治性哮喘病人支气管热成形术后的应用及机制研究

Application and mechanism of nasal high flow oxygen therapy with heating and humidification after bronchoplasty in patients with refractory asthma

目的探讨加温加湿经鼻高流量氧疗对难治性哮喘病人支气管热成形术(BT)后的应用及机制。方法选择2021年1月至2022年10月在中国科学院大学深圳医院(光明)拟行BT的哮喘病人118例进行研究。采用随机数字表法将病人分为两组,每组各59例。两组均行BT治疗,术后对照组病人给予常规鼻导管吸氧,观察组则行经鼻高流量氧疗(HFNC)。比较两组病人临床疗效、痰液黏稠度、舒适度、生活质量、炎症因子、呼出气一氧化氮(FeNO)、血气分析指标及疗程结束后3周内并发症发生情况。结果观察组病人显效率、总有效率分别为64.41%、96.61%,高于对照组的38.98%、86.44%(P<0.05)。治疗后两组Ⅲ度黏痰占比、ACQ得分、TNF-α、FeNO及二氧化碳分压均低于治疗前,但观察组低于对照组;治疗后两组CQC得分、AQLQ得分、ACT得分、IL-10、氧分压均高于治疗前,但观察组高于对照组(P<0.05)。治疗后两组均高于治疗前,但观察组高于对照组(P<0.05)。两组治疗前后pH均差异无统计学意义(P>0.05)。对照组共出现16例(27.12%)并发症,高于观察组的6例(10.16%)并发症(P<0.05)。结论难治性哮喘病人BT后HFNC较常规鼻导管吸氧可有效提高临床疗效,提高病人舒适度与生活质量,降低痰液黏稠度;其机制可能与HFNC可改善炎症水平和血气分析指标、降低FeNO水平有关。

Objective To investigate the application and mechanism of warming and humidifying nasal high flow oxygen therapy in patients with refractory asthma after bronchoplasty.Methods From January 2021 to October 2022,118 asthmatic patients who were scheduled to undergo bronchoplasty in Shenzhen Hospital,University of Chinese Academy of Sciences(Guangdong)were studied.The patients were randomly divided into two groups with 59 cases in each group.The patients in the control group were given routine nasal catheter oxygen inhalation,and the patients in the observation group were given intranasal high flow oxygen therapy(HFNC).The clinical efficacy,sputum viscosity,comfort,quality of life,inflammatory factors,exhaled nitric oxide(FeNO),blood gas analysis indexes and complications within 3 weeks after operation were compared between the two groups.Results The apparent and total effective rates of patients in the observation group were 64.41%and 96.61%,respectively,which were higher than 38.98%and 86.44%in the control group(P<0.05).After treatment,the proportion of third-degree mucus,ACQ score,TNF of the two groups-α,FeNO and carbon dioxide partial pressure were lower than those before treatment,but the observation group was lower than the control group;After treatment,the CQC score,AQLQ score,ACT score,IL-10 and oxygen partial pressure of the two groups were higher than those before treatment,but the observation group was higher than the control group(P<0.05).After treatment,both groups were higher than before treatment,but the observation group was higher than the control group(P<0.05).There was no significant difference in pH between the two groups before and after treatment(P>0.05).There were 16 cases(27.12%)of complications in the control group,which was higher than 6 cases(10.16%)in the observation group(P<0.05).Conclusions Compared with conventional nasal catheter oxygen inhalation after bronchial thermoplasty in patients with refractory asthma,HFNC can effectively improve the clinical efficacy,improve patients'comfort and quality of life,and reduce sputum viscosity.The mechanism may be related to the fact that HFNC can improve the level of inflammation and blood gas analysis indicators,and it can reduce the level of FeNO.