HFNC与NPPV在AECOPD伴Ⅱ型呼吸衰竭中的疗效分析

doi:10.3877/cma.j.issn.1674-6902.2023.06.012

目的

分析经鼻高流量湿化氧疗(high-flow nasal cannula oxygen therapy, HFNC)与无创正压通气(non-invasive positive pressure ventilation, NPPV)对慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)伴Ⅱ型呼吸衰竭的疗效。

方法

选取2020年1月至2023年6月我院收治的AECOPD伴Ⅱ型呼吸衰竭患者37例为对象，随机分成观察组17例与对照组20例。观察组采用HFNC，对照组采用NPPV。对比治疗24 h、出院时的APACHE Ⅱ评分、血气分析及心率、呼吸频率、氧饱和度指标，比较住院治疗过程中气道管理干预次数、氧疗累计时间及疗效不佳。

结果

治疗24 h后，两组APACHE Ⅱ评分、血氧饱和度、心率、呼吸频率和血气分析无差异性(P>0.05)，观察组氧疗累计(17.06±2.82)h长于对照组(12.00±1.41)h(P<0.05)，气道管理干预(5.18±1.42)次低于对照组(8.50±2.84)次(P<0.05)；出院时两组APACHE Ⅱ评分、血氧饱和度、心率、呼吸频率、血气参数差异无统计学意义(P>0.05)，观察组鼻面部皮肤损伤1例(5.88%)、气道管理干预(30.25±7.99)次、氧疗累计(125.50±19.71)h，对照组鼻面部皮肤损伤7例(35.00%)、气道管理干预(38.17±10.44)次、氧疗累计(92.33±24.73)h(P<0.05)；观察组治疗不佳5例(29.41%)，对照组8例(40.00%)(P>0.05)；观察组治疗不耐受例数低于对照组(P<0.05)。

结论

HFNC与NPPV治疗AECOPD伴Ⅱ型呼吸衰竭的疗效无差异性，HFNC耐受性好，优于NPPV。

关键词: 急性加重期，肺疾病，慢性阻塞性, Ⅱ型呼吸衰竭, 经鼻高流量氧疗, 无创正压通气, 二氧化碳潴留, 耐受性

Objective

To compare the curative effect of high-flow nasal cannula oxygen therapy(HFNC) with non-invasive positive pressure ventilation(NPPV) on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with type Ⅱ respiratory failure.

Methods

A total of 37 patients with AECOPD complicated with type Ⅱ respiratory failure in our hospital from January 2020 to June 2023 were selected, and they were randomly divided into observation (17 cases) and control group (20 cases), which were given HFNC or NPPV respectively on the basis of conventional treatments. APACHE Ⅱ, blood gas analysis, heart rate, respiratory rate and SaO₂ of patients in the two groups were compared at 24-hour after admission and at discharge respectively. Moreover, number of airway care intervention, accumulated time of oxygen therapy, and treatment failure of two groups were compared during the treatment process.

Results

APACHE-Ⅱ, blood gas analysis, heart rate, respiratory rate and SaO₂ of patients in two groups showed no significant difference between the two groups (P>0.05) at 24-hour after admission and at discharge. The duration of oxygen therapy (17.06±2.82) h in the observation group was longer than that in the control group (12.00±1.41) h, P<0.05, and the duration of airway nursing intervention (5.18±1.42) was lower than that in the control group (8.50±2.84)(P<0.05). At discharge, there were no significant differences in APACHE Ⅱ score, blood oxygen saturation, heart rate, respiratory rate and blood gas parameters between the two groups (P>0.05). In the observation group, there was 1 case of nasal and facial skin injury (5.88%), airway care intervention (30.25±7.99) times, and oxygen therapy accumulated (125.50±19.71)h, while in the control group, there were 7 cases of nasal and facial skin injury (35.00%), airway care intervention (38.17±10.44) times, and oxygen therapy accumulated (92.33±24.73)h, P<0.05; There were 5 cases (29.41%) of poor treatment in observation group and 8 cases (40.00%) in control group, P>0.05. The number of treatment intolerance cases in observation group was lower than that in control group (P<0.05).

Conclusion

HFNC has similar curative effect with NPPV, but HFNC is better than NPPV due to higher tolerance.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Type Ⅱ respiratory failure, High-flow nasal cannula oxygen therapy, Non-invasive positive pressure ventilation, Carbon dioxide retention, tolerance

表1 两组AECOPD患者治疗前、治疗后24 h临床参数(±s)

临床资料	治疗前		t值	P值	治疗后24 h		t值	P值
临床资料	观察组(n＝17)	对照组(n＝20)	t值	P值	观察组(n＝17)	对照组(n＝20)	t值	P值
APACHE Ⅱ评分	17.41±2.27	17.10±1.83	0.463	0.646	15.47±1.90^a	15.25±0.91^b	0.436	0.667
血氧饱和度(%)	73.29±3.06	74.75±2.81	1.509	0.140	95.00±1.84^a	94.65±2.13^b	0.529	0.600
心率(次/min)	100.18±4.61	102.10±2.90	1.487	0.149	100.53±5.08	101.20±4.50	0.426	0.673
呼吸频率(次/min)	28.47±1.81	28.65±1.60	0.320	0.750	22.71±0.99^a	22.40±1.05^b	0.910	0.369
血气分析
pH	7.35±0.02	7.35±0.01	0.526	0.602	7.41±0.39^a	7.41±0.04^b	0.168	0.868
PaCO₂(mmHg)	76.59±1.58	77.20±1.28	1.299	0.202	63.94±1.85^a	64.10±1.89^b	0.257	0.799
PaO₂(mmHg)	49.47±2.45	49.70±2.86	0.316	0.754	79.18±0.95^a	79.00±1.03^b	0.539	0.593
PaO₂/FiO₂(mmHg)	129.53±1.87	129.55±1.82	0.034	0.973	169.88±1.73^a	170.30±1.69^b	0.742	0.463
HFNC或NPPV设备累计使用时间(h)	－	－	－	－	17.06±2.82	12.00±1.41	6.720	0.000^c
气道管理干预(次)	－	－	－	－	5.18±1.42	8.50±2.84	4.600	0.000^c

表1 两组AECOPD患者治疗前、治疗后24 h临床参数(±s)

临床资料	治疗前		t值	P值	治疗后24 h		t值	P值
临床资料	观察组(n＝17)	对照组(n＝20)	t值	P值	观察组(n＝17)	对照组(n＝20)	t值	P值
APACHE Ⅱ评分	17.41±2.27	17.10±1.83	0.463	0.646	15.47±1.90^a	15.25±0.91^b	0.436	0.667
血氧饱和度(%)	73.29±3.06	74.75±2.81	1.509	0.140	95.00±1.84^a	94.65±2.13^b	0.529	0.600
心率(次/min)	100.18±4.61	102.10±2.90	1.487	0.149	100.53±5.08	101.20±4.50	0.426	0.673
呼吸频率(次/min)	28.47±1.81	28.65±1.60	0.320	0.750	22.71±0.99^a	22.40±1.05^b	0.910	0.369
血气分析
pH	7.35±0.02	7.35±0.01	0.526	0.602	7.41±0.39^a	7.41±0.04^b	0.168	0.868
PaCO₂(mmHg)	76.59±1.58	77.20±1.28	1.299	0.202	63.94±1.85^a	64.10±1.89^b	0.257	0.799
PaO₂(mmHg)	49.47±2.45	49.70±2.86	0.316	0.754	79.18±0.95^a	79.00±1.03^b	0.539	0.593
PaO₂/FiO₂(mmHg)	129.53±1.87	129.55±1.82	0.034	0.973	169.88±1.73^a	170.30±1.69^b	0.742	0.463
HFNC或NPPV设备累计使用时间(h)	－	－	－	－	17.06±2.82	12.00±1.41	6.720	0.000^c
气道管理干预(次)	－	－	－	－	5.18±1.42	8.50±2.84	4.600	0.000^c

表2 两组AECOPD患者出院时临床指标结果(±s)

临床资料	观察组(n＝17)	对照组(n＝20)	t/χ²	P值
APACHE Ⅱ评分	10.17±1.11	9.75±1.29	0.847	0.406
SaO₂(%)	97.58±0.90	97.83±1.03	0.633	0.533
心率(次/min)	80.92±1.78	82.50±2.39	1.838	0.080
呼吸频率(次/min)	21.58±1.78	21.33±2.57	0.277	0.785
pH	7.42±0.01	7.42±0.02	0.270	0.790
PaCO₂(mmHg)	44.92±1.93	44.50±1.73	0.557	0.583
PaO₂(mmHg)	93.83±2.66	93.83±2.66	1.033	0.313
PaO₂/FiO₂(mmHg)	287.33±20.20	285.58±21.77	0.977	0.250
鼻面部皮肤损伤	1	7	6.750	0.009
胃肠胀气	0	5	－	0.037
HFNC或NPPV累计使用时间(h)	125.50±19.71	92.33±24.73	3.633	0.001
气道管理干预(次)	30.25±7.99	38.17±10.44	2.086	0.049
总住院时间(d)	15.50±5.63	16.83±8.99	0.436	0.668

表2 两组AECOPD患者出院时临床指标结果(±s)

临床资料	观察组(n＝17)	对照组(n＝20)	t/χ²	P值
APACHE Ⅱ评分	10.17±1.11	9.75±1.29	0.847	0.406
SaO₂(%)	97.58±0.90	97.83±1.03	0.633	0.533
心率(次/min)	80.92±1.78	82.50±2.39	1.838	0.080
呼吸频率(次/min)	21.58±1.78	21.33±2.57	0.277	0.785
pH	7.42±0.01	7.42±0.02	0.270	0.790
PaCO₂(mmHg)	44.92±1.93	44.50±1.73	0.557	0.583
PaO₂(mmHg)	93.83±2.66	93.83±2.66	1.033	0.313
PaO₂/FiO₂(mmHg)	287.33±20.20	285.58±21.77	0.977	0.250
鼻面部皮肤损伤	1	7	6.750	0.009
胃肠胀气	0	5	－	0.037
HFNC或NPPV累计使用时间(h)	125.50±19.71	92.33±24.73	3.633	0.001
气道管理干预(次)	30.25±7.99	38.17±10.44	2.086	0.049
总住院时间(d)	15.50±5.63	16.83±8.99	0.436	0.668

1	Abe T, Takagi T, Fujii T. Update on the management of acute respiratory failure using non-invasive ventilation and pulse oximetry[J]. Crit Care, 2023, 27(1): 92.
2	Nagata K, Horie T, Chohnabayashi N, et al. Home high-flow nasal cannula oxygen therapy for stable hypercapnic COPD: a randomized clinical trial[J]. Am J Respir Crit Care Med, 2022, 206(11): 1326-1335.
3	Xia JG, Gu SC, Lei W, et al. High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial[J]. Crit Care, 2022, 26(1): 109.
4	曹启凤，刘永琴，杨　楠. AECOPD患者血清MnSOD、CuZnSOD变化及其与疾病转归的关系[J]. 国际检验医学杂志，2023, 44(16): 1934-1937, 1943.
5	Roberts CM, Brown JL, Reinhardt AK, et al. Non-invasive ventilation in chronic obstructive pulmonary disease: management of acute type 2 respiratory failure[J]．Clin Med (Lond), 2008, 8(5): 517-521.
6	王琼娅，乐文卿，余　浩. APACHEⅡ评分和CAPS评分在慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者预后评估的应用[J]. 实用临床医药杂志，2016, 20(11): 25-27.
7	Kim DK, Lee J, Park JH, et al. What can we apply to manage acute exacerbation of chronic obstructive pulmonary disease with acute respiratory failure? [J]．Tuberc Respir Dis (Seoul), 2018, 81(2): 99-105.
8	Osadnik CR, Tee VS, Carson-Chahhoud KV, et al. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev, 2017, 7(7): CD004104.
9	Scala R, Heunks L. Highlights in acute respiratory failure[J]. Eur Respir Rev, 2018, 27(147): 180008.
10	Davidson AC, Banham S, Elliott M, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults[J]. Thorax, 2016, 71(2): ii1-35.
11	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.
12	Conti G, Antonelli M, Navalesi P, et al. Conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial[J]. Intensive Care Med, 2002, 28(12): 1701-1707.
13	吴可人，徐　健. 经鼻高流量氧疗与无创正压通气联合治疗慢性阻塞性肺疾病急性加重期患者的效果[J]. 中国临床医学，2020, 27(5): 831-833.
14	Hadda V, Shah TH, Madan K, et al. Noninvasive ventilation-neurally adjusted ventilator assist for management of acute exacerbation of chronic obstructive pulmonary disease[J]. Lung India, 2018, 35(1): 62-65.
15	程　宁，彭　爽. 夜间无创正压通气治疗慢性阻塞性肺疾病合并高碳酸血症呼吸衰竭患者的疗效[J]. 中国老年学杂志，2018, 38(5): 1117-1119.
16	王　虹，王　琳，王　悦，等. 无创正压通气治疗失败行延迟气管插管对预后的影响分析[J]. 中国医刊，2019, 54(11): 1193-1196.
17	Chandra D, Stamm JA, Taylor B, et al. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States，1998-2008[J]. Am J Respir Crit Care Med, 2012, 185(2): 152-159.
18	Gay PC. Complications of noninvasive ventilation in acute care[J]. Respir Care, 2009, 54(2): 246-57.
19	Pilcher J, Eastlake L, Richards M, et al. Physiological effects of titrated oxygen via nasal high-flow cannulae in COPD exacerbations: A randomized controlled cross-over trial[J]. Respirology, 2017, 22(6): 1149-1155.
20	任成山，王关嵩，钱桂生. 慢性阻塞性肺疾病的成因及其治疗的困惑与希望[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(2): 127-141.
21	Bruni A, Garofalo E, Cammarota G, et al. High flow through nasal cannula in stable and exacerbated chronic obstructive pulmonary disease patients[J]. Rev Recent Clin Trials, 2019, 14(4): 247-260.
22	Nishimura M. High-flow nasal cannula oxygen therapy devices[J]. Respir Care, 2019, 64(6): 735-742.
23	Cortegiani A, Longhini F, Madotto F, et al. High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial[J]. Crit Care, 2020, 24(1): 692.
24	Feng Z, Zhang L, Yu H, et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for AECOPD patients after extubation: a systematic review and meta-analysis of randomized controlled trials[J]. Int J Chron Obstruct Pulmon Dis, 2022, 30(17): 1987-1999.
25	Ospina-Tascón GA, Calderón-Tapia LE, García AF, et al. Effect of high-flow oxygen therapy vs vonventional oxygen therapy on invasive mechanical ventilation and clinical recovery in patients with severe COVID-19: A Randomized Clinical Trial[J]. JAMA, 2021, 326(21): 2161-2171.
26	Ritchie JE, Williams AB, Gerard C, et al. Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures[J]. Anaesth Intensive Care, 2011, 39(6): 1103-1110.
27	吴永强，葛秉宜，李　莹，等. 不同时间段BiPAP呼吸机在老年Ⅱ型呼吸衰竭患者中的临床分析[J/CD]. 中华肺部疾病杂志(电子版), 2022, 15(4): 574-576.
28	周建珍，张传来，徐　莉，等. 经鼻高流量氧疗不同流速设置对急性低氧性呼吸衰竭患者的影响[J]. 中华护理杂志，2022, 57(15): 1797-1803.
29	Fricke K, Tatkov S, Domanski U, et al. Nasal high flow reduces hypercapnia by clearance of anatomical dead space in a COPD patient[J]. Respir Med Case Rep, 2016, 19: 115-117.
30	Millar J, Lutton S, O′Connor P. The use of high-flow nasal oxygen therapy in the management of hypercarbic respiratory failure[J]. Ther Adv Respir Dis, 2014, 8(2): 63-64.
31	Pavlov I, Plamondon P, Delisle S. Nasal high-flow therapy for type II respiratory failure in COPD: A report of four cases[J]. Respir Med Case Re, 2017, 20(1): 87-88.
32	吴志峰，杨小雪，卓　越，等. NIPPV与HFNC治疗AECOPD合并中度Ⅱ型呼吸衰竭的疗效比较[J]. 徐州医科大学学报，2021, 41(2): 122-126.

[1]	岳伟岗, 蒋由飞, 尹瑞元, 吴雨晨, 曾丽, 田金徽. 经鼻高流量氧疗对急性低氧性呼吸衰竭患者住院病死率的累积Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(01): 39-44.
[2]	王亚岚, 倪婧, 余世庆, 陶银花, 张荣. 尼达尼布抗纤维化治疗特发性肺纤维化的耐受性和疗效预测因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 750-755.
[3]	方晓玉, 王婷, 赵珊, 陈锋. HALP指数对AECOPD并发呼吸衰竭患者ICU结局的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 639-641.
[4]	杨万荣, 任治坤, 时新颍. 沙丁胺醇雾化吸入脾多肽治疗AECOPD的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 609-612.
[5]	程炜炜, 张青, 张诚实, 冯契靓, 陈荣荣, 赵云峰. 全身免疫炎症指数与慢性阻塞性肺疾病急性加重期病情严重程度相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 580-584.
[6]	袁广琴, 朱珠, 林云霞. 胸腺肽联合无创正压通气救治AECOPD并发Ⅱ型呼吸衰竭患者的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 438-441.
[7]	陈杨, 李茜, 杨中华. 慢性阻塞性肺疾病急性加重期合并VTE抗凝治疗的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 316-319.
[8]	周文欢, 杨黎. AECOPD低钠血症发生风险及预测因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 313-315.
[9]	陈婷婷, 李春娟. 经鼻高流量湿化氧疗治疗AECOPD伴Ⅱ型呼吸衰竭的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 276-279.
[10]	周玲, 吴园明. 复方异丙托溴铵对AECOPD患者肺功能及血清IGF-Ⅱ、SOD水平的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(01): 103-106.
[11]	赵雅, 张丽, 季学丽, 黄夕华, 李晨, 金伦. 急诊早期气道规范化管理对AECOPD并发呼吸衰竭预后的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(01): 134-136.
[12]	商焕霞, 郭立娟, 张罗元, 徐婵, 席素雅. AECOPD患者肺功能指标与血清白介素相关因子水平的关系[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(01): 123-126.
[13]	赵哲宇, 张建, 沈琦. 布地格福吸入气雾剂对AECOPD患者肺功能及Hs-CRP、IgE水平的影响[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(06): 826-828.
[14]	李海亮, 俞云, 张星星, 陈管洁, 刘玲, 谢剑锋, 常炜. 经鼻高流量氧疗在危重症患者气管插管过程中效果的荟萃分析[J/OL]. 中华重症医学电子杂志, 2024, 10(03): 227-235.
[15]	何秀, 敖的, 杨郑, 林小华. 改良呼吸支持策略对慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者的疗效[J/OL]. 中华卫生应急电子杂志, 2024, 10(03): 140-144.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Curative effect comparison between HFNC and NPPV in patients with AECOPD complicated with type Ⅱ respiratory failure

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Curative effect comparison between HFNC and NPPV in patients with AECOPD complicated with type Ⅱ respiratory failure