不同氧流量经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重期患者临床疗效及短期预后影响因素分析

Clinical efficacy of high-flow nasal cannula oxygen therapy with different oxygen flow rates in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease and analysis of influencing factors for short-term prognosis

目的探讨不同氧流量经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效,并筛选氧流量设置为60 L/min的HFNC治疗患者短期预后的影响因素。方法选取自2022年6月至2023年6月崇州市人民医院收治的150例AECOPD患者为研究对象,采用随机数字表法将患者分为低流量组、中流量组、高流量组,每组各50例。3组均给予HFNC治疗,其中,低流量组氧流量为30 L/min,中流量组氧流量为40 L/min,高流量组氧流量为60 L/min,持续治疗7 d。比较3组患者治疗后24 h短期疗效。治疗前、治疗后,比较3组动脉血气指标[二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))]、肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、呼气峰值流量(PEF)],以及症状严重程度[慢性阻塞性肺疾病评估测试(CAT)、呼吸困难指数(mMRC)评分]。高流量组患者在经HFNC治疗后随访28 d,根据28 d疾病转归情况分为预后良好组(n=32)与预后不良组(n=18),分析氧流量设置为60 L/min的HFNC治疗患者短期预后影响因素。结果治疗后,3组PaCO_(2)低于治疗前,PaO_(2)、FVC、FEV1、PEF水平高于治疗前,差异有统计学意义(P<0.05)。治疗后,高流量组、中流量组PaCO_(2)低于低流量组,且高流量组低于中流量组;高流量组、中流量组PaO_(2)、FVC、FEV1、PEF水平高于低流量组,且高流量组高于中流量组,差异有统计学意义(P<0.05)。治疗后,3组患者CAT评分、mMRC评分低于治疗前,差异有统计学意义(P<0.05)。治疗后,高流量组、中流量组CAT评分、mMRC评分低于低流量组,且高流量组低于中流量组,差异有统计学意义(P<0.05)。高流量组、中流量组总有效率高于低流量组,且高流量组总有效率高于中流量组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、吸烟史、急性生理学与慢性健康评分、C反应蛋白、降钙素原、PaCO_(2)、PaO_(2)、CAT评分、mMRC评分、HFNC短期疗效是影响高流量HFNC治疗AECOPD短期预后的独立危险因素(P<0.05)。结论高流量HFNC可更好地改善AECOPD患者动脉血气、肺功能,提高短期疗效,但仍有部分患者受年龄、吸烟史、急性生理学与慢性健康评分、C反应蛋白、降钙素原、PaCO_(2)、PaO_(2)、CAT评分、mMRC评分、HFNC短期疗效等因素影响,预后不佳,临床中可根据上述危险因素早期制定相关措施以改善短期预后。

Objective To investigate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)with different oxygen flow rates in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and screen the influencing factors of short-term prognosis in patients treated with HFNC setting oxygen flow rate at 60 L/min.Methods A total of 150 AECOPD patients admitted to Chongzhou People′s Hospital from June 2022 to June 2023 were selected and divided into the low flow group,medium flow group and high flow group by random number table method,with 50 cases in each group.All the three groups were given HFNC treatment for 7 days,in which the oxygen flow rate of the low flow group was 30 L/min,the oxygen flow rate of the medium flow group was 40 L/min,and the oxygen flow rate of the high flow group was 60 L/min.The short-term efficacy at 24 hours after the treatment was compared among the three groups.Before and after the treatment,arterial blood gas indicators[partial pressure of carbon dioxide(PaCO_(2)),oxygen partial pressure(PaO_(2))],pulmonary function[forced vital capacity(FVC),first second forced expiratory volume(FEV1),peak expiratory flow rate(PEF)],and symptom severity[chronic obstructive pulmonary disease assessment test(CAT),modified medical research council(mMRC)score]were compared among the three groups.Patients in the high flow group were followed up for 28 days after HFNC treatment,and divided into the good prognosis group(n=32)and the poor prognosis group(n=18)based on their disease outcomes.The influencing factors of short-term prognosis in patients treated with HFNC setting oxygen flow rate at 60 L/min were analyzed.Results After the treatment,the PaCO_(2) of the three groups was lower than that before the treatment,while the PaO_(2),FVC,FEV1,and PEF of the three groups were higher than those before the treatment,with statistically significant differences(P<0.05).After the treatment,PaCO_(2) in the high flow group and medium flow group was lower than that in the low flow group,and the high flow group was lower than the medium flow group,PaO_(2),FVC,FEV1 and PEF in the high flow group and medium flow group were higher than those in the low flow group,and the high flow group were higher than the medium flow group,with statistical significance(P<0.05).After the treatment,the CAT score and mMRC score of the three groups were lower than before the treatment,and the difference was statistically significant(P<0.05).After the treatment,the CAT score and mMRC score of the high flow group and the medium flow group were lower than those of the low flow group,and the high flow group was lower than the medium flow group,with statistical significance(P<0.05).The total effective rate of the high flow group and the medium flow group was higher than that of the low flow group,and the high flow group was higher than the medium flow group,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that age,smoking history,acute physiology and chronic health scores,C-reactive protein,procalcitonin,PaCO_(2),PaO_(2),CAT score,mMRC score,and short-term efficacy of HFNC were independent risk factors affecting the short-term prognosis of high flow HFNC treatment for AECOPD(P<0.05).Conclusion High flow HFNC can better improve arterial blood gas and lung function in AECOPD patients,and enhance short-term efficacy.However,some patients are still affected by age,smoking history,acute physiology and chronic health scores,C-reactive protein,procalcitonin,PaCO_(2),PaO_(2),CAT score,mMRC score,and short-term efficacy of HFNC,and the prognosis is poor.This suggests that clinical measures can be developed early based on the above risk factors to improve short-term prognosis.