慢性阻塞性肺疾病急性加重并呼吸衰竭经鼻高流量氧疗临床疗效分析

Clinical analysis on effect of nasal high-flow oxygen therapy in acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

目的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一种严重危害人类健康的常见病,本研究探讨经鼻高流量氧疗对慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)并呼吸衰竭患者的临床疗效和膈肌功能的影响。方法选取2018-01-01-2018-12-01济宁医学院附属湖西医院收治的AECOPD(临床分级Ⅱ级)患者为研究对象,分为治疗组26例,对照组28例,两组均给予支气管扩张药物、糖皮质激素、祛痰和抗感染等治疗,治疗组同时行经鼻高流量氧疗(high-flow nasal cannula,HFNC),对照组行鼻导管低流量吸氧,床旁超声测量患者膈肌移动度,比较两组治疗前与治疗后2、24、48h平静呼吸膈肌移动度(diaphragm excursion during quiet breathing,DEq)、深呼吸膈肌移动度(diaphragm excursion during deep breathing,DEd)、动脉血氧分压(arterial partial pressure of oxygen,PaO_2)、动脉血二氧化碳分压(partial pressure of carbon dioxide,PCO_2),气管插管率和28d病死率。结果治疗后两组DEq均下降,治疗组下降更早,治疗2h后,治疗组为(19.2±3.7)mm,低于对照组的(21.4±4.1)mm,差异有统计学意义,t=-2.129,P=0.038;治疗24h后,治疗组为(18.2±3.2)mm,低于对照组的(20.3±3.8)mm,t=-2.171,P=0.035。两组DEd治疗后均逐渐增加,但治疗组增加更显著,治疗48h后,治疗组DEd为(54.5±11.7)mm,高于对照组的(48.4±10.1)mm,差异有统计学意义,t=2.053,P=0.045。治疗2h后,治疗组PCO_2为(65.1±9.2)mm Hg,低于对照组的(71.5±11.4)mm Hg,差异有统计学意义,t=-2.267,P=0.028;治疗24h后,治疗组为(59.7±9.2)mm Hg,低于对照组的(67.8±13.8)mm Hg,差异有统计学意义,t=-2.536,P=0.015;治疗48h后,治疗组为(54.7±10.4)mm Hg,低于对照组的(63.9±19.4)mm Hg,差异有统计学意义,t=-2.171,P=0.036。治疗后两组PaO_2均显著升高,差异无统计学意义,均P>0.05。治疗组气管插管率和病死率与对照组比较,差异均无统计学意义,均P>0.05。结论 HFNC能有效缓解AECOPD并呼吸衰竭患者的膈肌疲劳,改善通气功能,降低二氧化碳潴留。

OBJECTIVE Chronic obstructive pulmonary disease(COPD)is a common disease that seriously endangers human health.The study aims to investigate the effect of nasal high-flow oxygen therapy on the clinical efficacy and diaphragm function of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure.METHODS AECOPD patients with respiratory failure patients(Clinical classificationⅡ)admitted to Huxi Affiliated Hospital of Jining Medical College were enrolled.The patients were divided into treatment group(n=26)and control group(n=28)by randomly number table method.The two groups were given bronchiectasis drugs,corticosteroids,expectorant,anti-infection treatment.At the same time the treatment group was given nose high flow oxygen therapy(high-flow nasal cannula,HFNC),the control group was given low flow oxygen.Bedside ultrasound was used to measure the patients’diaphragmatic motion,and the differences between the two groups of patients before treatment,2,24 and 48 hafter treatment were compared in diaphragmatic excursions during quiet breathing(DEq),diaphragmatic excursions during deep breathing(DEd),arterial oxygen partial pressure(PaO2),arterial partial pressure of carbon dioxide(PCO2)and tracheal intubation rate,mortality at 28 d.RESULTS There were no statistically significant differences in DEq,DEd,PaO2 and PCO2 between the two groups before treatment(all P>0.05).After treatment,DEq decreased in both groups,and it decreased earlier in the treatment group.After treatment for 2 h[(19.2±3.7)mmvs(21.4±4.1)mm]and 24 h[(18.2±3.2)mmvs(20.3±3.8)mm],it was significantly lower than that in the control group(all P<0.05).DEd increased especially in the treatment group.After treatment for 48 h[(54.5±11.7)mmvs(48.4±10.1)mm],it was significantly higher than that in the control group(P=0.045).After treatment,PCO2 in the treatment group decreased significantly,with 2 h[(65.1±9.2)mm Hg vs(71.5±11.4)mm Hg],24 h[(59.7±9.2)mm Hg vs(67.8±13.8)mm Hg]and 48 h[(54.7±10.4)mm Hg vs(63.9±19.4)mm Hg]significantly lower than those in the control group,all P<0.05.After treatment,there were no statistically significant differences in PaO2 between the two groups,all P>0.05.The rate of tracheal intubation(7.7%vs 28.6%)and mortality(3.8%vs 7.1%)in the treatment group were both lower than those in the control group,but the differences were not statistically significant,all P>0.05.CONCLUSION HFNC can effectively relieve the diaphragm fatigue of patients with AECOPD with respiratory failure,improve the pulmonary ventilation function,and reduces carbon dioxide retention.