经鼻高流量氧疗治疗AECOPD伴Ⅱ型呼吸衰竭的疗效

doi:10.3969/j.issn.1000-8535.2023.09.010

摘要/Abstract

摘要： 目的观察经鼻高流量氧疗治疗慢性阻塞性肺疾病急性加重期（AECOPD）伴Ⅱ型呼吸衰竭对患者肺功能、血气分析指标的影响。方法收集2020年3月—2022年3月我院收治的AECOPD伴Ⅱ型呼吸衰竭患者92例,随机分为常规通气组（46例,无创正压通气）、经鼻氧疗组（46例,经鼻高流量氧疗）,测量记录治疗前及治疗后2组患者心率及呼吸频率、血气分析指标、肺功能指标,评估患者舒适度及呼吸困难情况,记录治疗期间并发症。结果治疗后经鼻氧疗组心率、呼吸频率低于常规通气组（P<0.05）;治疗后经鼻氧疗组二氧化碳分压（PaCO₂）低于常规通气组,动脉血氧分压（PaO₂）高于常规通气组（P<0.05）;治疗后经鼻氧疗组第1秒用力呼出气容积（FEV₁）、用力呼气容积（FVC）高于常规通气组（P<0.05）;治疗后经鼻氧疗组Borg评分低于常规通气组,舒适率高于常规通气组（P<0.05）;经鼻氧疗组并发症发生率低于常规通气组（P<0.05）。结论给予AECOPD伴Ⅱ型呼吸衰竭患者经鼻高流量氧疗可改善患者肺功能、血气分析指标,促进呼吸困难症状缓解,且可提高患者舒适度,降低并发症发生率。

关键词: 慢性阻塞性肺疾病急性加重期, Ⅱ型呼吸衰竭, 经鼻高流量氧疗, 血气分析, 肺功能, 随机对照

Abstract: Objective To observe the effect of nasal high-flow oxygen therapy on pulmonary function and blood gas analysis indexes in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）with type Ⅱ respiratory failure．Methods From March 2020 to March 2022,92 patients with AECOPD complicated with type Ⅱ respiratory failure who were treated in our hospital were enrolled and randomly divided into conventional ventilation group（46 cases,non-invasive positive pressure ventilation）and nasal oxygen therapy group（46 cases,nasal high-flow oxygen therapy）．The heart rate and respiratory rate,blood gas analysis indexes,pulmonary function indexes of the two groups of patients before and after treatment were measured and recorded,the comfort level and dyspnea situation of the patients were evaluated,and the complications during the treatment were recorded．Results After treatment,the heart rate and respiratory rate in the nasal oxygen therapy group were significantly lower than those in the conventional ventilation group（P<0.05）．The partial pressure of carbon dioxide（PaCO₂）in the nasal oxygen therapy group was significantly lower than that in the conventional ventilation group,partial pressure of oxygen（PaO₂）was significantly higher than the conventional ventilation group（P<0.05）．The nasal oxygen therapy group forced expiratory volume in one second,（FEV₁）,forced vital capacity（FVC）were significantly higher than the conventional ventilation group（P<0.05）．The Borg score of nasal oxygen therapy group was significantly lower than the conventional ventilation group,the comfort level was significantly higher than the conventional ventilation group（P<0.05）．The incidence of complications in the nasal oxygen therapy group was significantly lower than that in the conventional ventilation group（P<0.05）．Conclusions Nasal high-flow oxygen therapy for AECOPD patients with type Ⅱ respiratory failure can significantly improve the pulmonary function and blood gas analysis indicators,promote the relief of dyspnea symptoms,improve the comfort level of patients,and reduce the incidence of complications．

Key words: acute exacerbation of chronic obstructive pulmonary disease, type Ⅱ respiratory failure, nasal high-flow oxygen therapy, blood gas analysis, pulmonary function, randomized control

严经煌, 魏坦明, 龚文, 陈菲. 经鼻高流量氧疗治疗AECOPD伴Ⅱ型呼吸衰竭的疗效[J]. 广州医药, 2023, 54(9): 58-63.

YAN Jinghuang, WEI Tanming, GONG Wen, CHEN Fei. Efficacy of nasal high-flow oxygen therapy in the treatment of AECOPD with type Ⅱ respiratory failure[J]. Guangzhou Medical Journal, 2023, 54(9): 58-63.

参考文献

[1] 张艳喜,尚龙梅,芮晓艳.经鼻高流量湿化氧疗及鼻导管氧疗治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的效果[J].中国医药导报,2022,19(7):112-115.
[2] 加娜提·安尼瓦尔,艾尔西丁·吾斯曼,阿布都扎依尔·买买提,等.高流量氧疗对慢性阻塞性肺疾病急性加重期合并中度Ⅱ型呼吸衰竭的治疗效果[J].贵州医科大学学报,2021,46(1):110-114.
[3] 冯小玲,青刚,邓太兵,等.无创正压通气间歇期使用经鼻高流量氧疗与鼻导管氧疗治疗老年慢性阻塞性肺疾病急性加重呼吸衰竭的临床分析[J].老年医学与保健,2021,27(3):547-550,563.
[4] MILLER D C,BIME C,PARTHARSARATHY S,et al.High-flow oxygen therapy concepts:time to standardize nomenclature and avoid confusion[J].J Intensive Care Med,2020,35(5):519-523.
[5] 王国玉,石文达,王璐,等.经鼻高流量湿化氧疗在COPD合并呼吸衰竭病人肺康复中的近期及远期疗效研究[J].实用老年医学,2022,36(1):53-56.
[6] 国家卫生健康委员会急诊医学质控中心,中华医学会急诊医学分会,中国医师协会急诊医师分会,等.中国慢性阻塞性肺疾病急性加重中西医诊治专家共识(2021)[J].中华危重病急救医学,2021,33(11):1281-1290.
[7] 袁秋影,刘美玲,黄松彬,等.低流量鼻导管氧疗患者非湿化给氧的效果及舒适度观察[J].护理学报,2011,18(10):37-39.
[8] 覃松梅,邓艺新,刘航,等.6 min步行试验和评分量表评估COPD的预后[J].临床与病理杂志,2021,41(10):2395-2399.
[9] 吴明,刘钦华,郭永明,等.福州市40岁及以上人群慢性阻塞性肺疾病流行病学调查分析[J].国际呼吸杂志,2020,40(2):107-113.
[10] 刘易其,李冬琼,陈明菊,等.经鼻高流量湿化氧疗与无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者疗效的研究[J].西南医科大学学报,2020,43(4):349-353.
[11] 王鑫,穆士伟,王孝侠,等.经鼻高流量氧疗在慢性阻塞性肺疾病急性加重无创通气后序贯治疗中的应用效果[J].中国中西医结合急救杂志,2022,29(3):292-296.
[12] 韩永艳,贾瑞华,陈培莉.经鼻高流量氧疗在老年慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭中的应用价值[J].临床内科杂志,2019,36(7):493-494.
[13] 刘峰,贾文娟,陈玉梅,等.经鼻高流量湿化氧疗在慢性阻塞性肺疾病急性加重期患者治疗中的应用研究[J].国际呼吸杂志,2018,38(16):1216-1219.
[14] 李宁,卢春兰,蒋碧佳,等.经鼻高流量氧疗与无创正压通气治疗老年慢阻肺合并Ⅱ型呼吸衰竭的临床研究[J].川北医学院学报,2020,35(3):489-492.
[15] 汪婉玲,王晓亮.经鼻高流量氧疗临床麻醉应用的研究进展[J].医学综述,2021,27(21):4321-4326.
[16] GODOY D,GRANEROS N,OYARZABAL L,et al.High-flow oxygen therapy in acute hypoxemic respiratory failure secondary to COVID-19 pneumonia.[J].Med intensiva(Engl Ed),2021,45(8):506-508.
[17] 梁金排,刘淑红,赵红玲,等.经鼻高流量氧疗对AECOPD患者血清淀粉样蛋白A及细胞因子的水平变化分析[J].河北医药,2021,43(10):1531-1534.
[18] 陈红梅,刘利.经鼻高流量湿化氧疗对AECOPD患者血气分析、再插管率及舒适度的影响[J].昆明医科大学学报,2019,40(7):116-119.
[19] 陈雪艳,楚玉雯,陈倩,等.高流量湿化氧疗对老年急性呼吸衰竭患者脱机成功率、血氧指标和气道引流的影响[J].实用医院临床杂志,2022,19(3):161-164.
[20] 高明昕,孟祥玲,张志辉,等.经鼻高流量氧疗在合并共病的老年急性呼吸衰竭病人中的应用价值[J].实用老年医学,2022,36(2):192-195.