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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (06) : 804 -808. doi: 10.3877/cma.j.issn.1674-6902.2023.06.012

论著

HFNC与NPPV在AECOPD伴Ⅱ型呼吸衰竭中的疗效分析
杨明福, 王永兴†()   
  1. 710054　西安，空军军医大学空军第986医院重症医学科
  • 收稿日期:2023-09-20 出版日期:2023-12-25
  • 通信作者: 王永兴
  • 基金资助:
    陕西省重点研发计划项目(2022SF-517)

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

Mingfu Yang, Yongxing Wang†()   

  1. Department of Critical Medicine, 986th Hospital of Air Force, Air Force Medical University, Xi′an 710054, China
  • Received:2023-09-20 Published:2023-12-25
  • Corresponding author: Yongxing Wang
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引用本文：

杨明福, 王永兴. HFNC与NPPV在AECOPD伴Ⅱ型呼吸衰竭中的疗效分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(06): 804-808.

Mingfu Yang, Yongxing Wang. Curative effect comparison between HFNC and NPPV in patients with AECOPD complicated with type Ⅱ respiratory failure[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(06): 804-808.

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
观察组(n＝17) 对照组(n＝20) 观察组(n＝17) 对照组(n＝20)
APACHE Ⅱ评分 17.41±2.27 17.10±1.83 0.463 0.646 15.47±1.90a 15.25±0.91b 0.436 0.667
血氧饱和度(%) 73.29±3.06 74.75±2.81 1.509 0.140 95.00±1.84a 94.65±2.13b 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±0.99a 22.40±1.05b 0.910 0.369
血气分析                
pH 7.35±0.02 7.35±0.01 0.526 0.602 7.41±0.39a 7.41±0.04b 0.168 0.868
PaCO2(mmHg) 76.59±1.58 77.20±1.28 1.299 0.202 63.94±1.85a 64.10±1.89b 0.257 0.799
PaO2(mmHg) 49.47±2.45 49.70±2.86 0.316 0.754 79.18±0.95a 79.00±1.03b 0.539 0.593
PaO2/FiO2(mmHg) 129.53±1.87 129.55±1.82 0.034 0.973 169.88±1.73a 170.30±1.69b 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 0.000c
气道管理干预(次) － － － － 5.18±1.42 8.50±2.84 4.600 0.000c
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
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