经鼻高流量氧疗与无创通气治疗慢性阻塞性肺疾病急性加重合并低氧血症的疗效比较

doi:10.3877/cma.j.issn.1674-6902.2025.05.013

中华肺部疾病杂志(电子版) ›› 2025, Vol. 18 ›› Issue (05) : 737 -741. doi: 10.3877/cma.j.issn.1674-6902.2025.05.013

论著

经鼻高流量氧疗与无创通气治疗慢性阻塞性肺疾病急性加重合并低氧血症的疗效比较

常亮¹, 王瀚宇¹, 徐阳²^,^†(

), 王建龙¹, 王宝¹, 郑国强¹, 郝巍山¹, 李小燕¹

¹710100　西安，西安国际医学中心医院急诊科
²710054　西安，西安市红会医院急诊科

收稿日期:2025-06-17 出版日期:2025-10-25
通信作者: 徐阳
基金资助:
陕西省自然科学基础研究计划项目(2022JM-490)

Comparison of the effects of high-flow nasal cannula oxygen therapy and non-invasive ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with hypoxemia

Liang Chang¹, Hanyu Wang¹, Yang Xu²^,^†(), Jianlong Wang¹, Bao Wang¹, Guoqiang Zheng¹, Weishan Hao¹, Xiaoyan Li¹

¹Department of Emergency, International Medical Center Hospital Xi′an 710100, China
²Department of Emergency, HongHui Hospital Xi′an 710054, China

Received:2025-06-17 Published:2025-10-25
Corresponding author: Yang Xu

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引用本文：

常亮, 王瀚宇, 徐阳, 王建龙, 王宝, 郑国强, 郝巍山, 李小燕. 经鼻高流量氧疗与无创通气治疗慢性阻塞性肺疾病急性加重合并低氧血症的疗效比较[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(05): 737-741.

Liang Chang, Hanyu Wang, Yang Xu, Jianlong Wang, Bao Wang, Guoqiang Zheng, Weishan Hao, Xiaoyan Li. Comparison of the effects of high-flow nasal cannula oxygen therapy and non-invasive ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with hypoxemia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(05): 737-741.

目的

比较经鼻高流量氧疗(high-flow nasal cannula oxygen therapy, HFNC)与无创通气(non-invasive ventilation, NIV)治疗慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)合并低氧血症的临床疗效。

方法

选择2021年5月至2024年6月我院收治的67例AECOPD合并低氧血症患者为对象，接受HFNC治疗32例为观察组，接受NIV治疗35例为对照组。对比两组生命体征、血气指标、肺功能及炎症指标。

结果

观察组治疗后呼吸频率(18.19±2.28)次/min、心率(81.05±7.20)次/min低于对照组(22.53±3.27)次/min、(85.36±8.04)次/min(P<0.05)；动脉血二氧化碳分压(arterial carbon dioxide partial pressure, PaCO₂)低于治疗前(P<0.05)，两组动脉血氧分压(arterial oxygen partial pressure, PaO₂)、氧合指数高于治疗前(P<0.05)。观察组治疗后用力肺活量(forced vital capacity, FVC)(2.05±0.41)L、每分钟最大通气量(maximal voluntary ventilation, MVV)(50.86±5.72)%、第一秒内用力呼气容积(forced expiratory volume in one second, FEV₁)(1.81±0.38)L高于对照组FVC(1.73±0.35)L、MVV(42.54±4.65)%、FEV₁(1.42±0.33)L(P<0.05)。观察组治疗后血清肺表面活性蛋白-D(surfactant protein-D, SP-D)(121.04±16.18)μg/L、肺部活化调节趋化因子/CC趋化因子18(pulmonary activation-regulated chemokine/CC type chemotactic factor 18, PARC/CCL18)(80.06±9.23)μg/L水平低于对照组SP-D(156.38±20.24)μg/L、PARC/CCL18(95.19±12.05)μg/L(P<0.05)。观察组鼻面部皮损率3.13%低于对照组20.00%(P<0.05)，观察组舒适度评分(8.72±0.30)分高于对照组(5.80±0.64)分(P<0.05)。观察组中生存30例(93.75%)，死亡2例(6.25%)，死因为呼吸衰竭；对照组中生存32例(91.43%)，死亡3例(8.57%)，死因为呼吸衰竭1例，合并感染2例。

结论

NIV与HFNC可调节AECOPD合并低氧血症患者血气指标，预后好，HFNC较NIV改善患者生命体征、肺功能，减轻炎症反应，提高舒适度，具有临床意义。

关键词: 急性加重期，肺疾病，慢性阻塞性, 无创通气, 经鼻高流量氧疗, 低氧血症

Objective

To compare the clinical effects of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypoxemia.

Methods

A total of 67 patients with AECOPD and hypoxemia admitted in our hospital from May 2021 to June 2024 were selected. Among them, 32 patients who received HFNC were assigned to the observation group, and 35 patients who received NIV were assigned to the control group. Vital signs, blood gas parameters, lung function, and inflammatory markers were compared between the two groups.

Results

After treatment, the respiratory rate (18.19±2.28) breaths/min and heart rate (81.05±7.20) beats/min in the observation group were lower than those in the control group (22.53±3.27) breaths/min, (85.36±8.04)beats/min (P<0.05). The arterial carbon dioxide partial pressure (PaCO₂) in the observation group was lower than before treatment (P<0.05), while the arterial oxygen partial pressure (PaO₂) and oxygenation index in both groups were higher than before treatment (P<0.05). After treatment, the forced vital capacity (FVC) (2.05±0.41)L, maximal voluntary ventilation (MVV) (50.86 ± 5.72)%, and forced expiratory volume in one second (FEV₁) (1.81±0.38)L in the observation group were higher than those in the control group FVC(1.73±0.35 L), MVV (42.54±4.65%), FEV₁ (1.42±0.33)L (P<0.05). The levels of serum surfactant protein-D (SP-D) (121.04±16.18) μg/L and pulmonary activation-regulated chemokine/CC type chemotactic factor 18 (PARC/CCL18) (80.06±9.23) μg/L in the observation group were lower than those in the control group SP-D(156.38±20.24)μg/L, PARC/CCL18 (95.19±12.05)μg/L (P<0.05). The rate of nasal and facial skin damage in the observation group (3.13%) was lower than that in the control group (20.00%) (P<0.05), and the comfort score in the observation group (8.72±0.30) was higher than that in the control group (5.80±0.64) (P<0.05). In the observation group, 30 patients survived (93.75%), and 2 died (6.25%), with the cause of death being respiratory failure. In the control group, 32 patients survived (91.43%), and 3 died (8.57%), with the causes of death being respiratory failure in 1 case and combined infection in 2 cases.

Conclusion

Both NIV and HFNC can regulate blood gas parameters in patients with AECOPD and hypoxemia, with favorable prognoses. However, compared to NIV, HFNC more effectively improves vital signs and lung function, reduces inflammatory responses, enhances comfort, and lowers the risk of nasal and facial skin damage.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Noninvasive ventilation, High-flow nasal cannula oxygen therapy, Hypoxemia

表1 两组AECOPD患者生命体征结果比较(

±s)

组　别	例数	呼吸频率(次/min)		平均动脉压(mmHg)		心率(次/min)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	29.67±4.58	18.19±2.28^a	86.21±5.73	88.23±5.98	95.38±9.12	81.05±7.20^a
对照组	35	28.13±4.25	22.53±3.27^a	88.54±6.26	86.38±6.37	98.54±9.67	85.36±8.04^a
t值		1.427	6.245	1.584	1.222	1.373	2.303
P值		0.158	0.000	0.118	0.226	0.174	0.024

表1 两组AECOPD患者生命体征结果比较(

±s)

组　别	例数	呼吸频率(次/min)		平均动脉压(mmHg)		心率(次/min)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	29.67±4.58	18.19±2.28^a	86.21±5.73	88.23±5.98	95.38±9.12	81.05±7.20^a
对照组	35	28.13±4.25	22.53±3.27^a	88.54±6.26	86.38±6.37	98.54±9.67	85.36±8.04^a
t值		1.427	6.245	1.584	1.222	1.373	2.303
P值		0.158	0.000	0.118	0.226	0.174	0.024

表2 两组AECOPD患者血气及PaO₂/FiO₂指标结果比较(

±s)

组　别	例数	PaCO₂(mmHg)		PaO₂(mmHg)		PaO₂/FiO₂
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	65.87±13.51	49.32±9.74^a	48.96±5.21	62.20±8.81^a	178.34±20.61	235.45±28.17^a
对照组	35	61.30±11.05	51.26±8.30^a	51.38±6.54	59.45±7.65^a	186.25±22.57	225.83±26.97^a
t值		1.521	0.879	1.664	1.367	1.493	1.427
P值		0.133	0.382	0.101	0.176	0.140	0.158

表2 两组AECOPD患者血气及PaO₂/FiO₂指标结果比较(

±s)

组　别	例数	PaCO₂(mmHg)		PaO₂(mmHg)		PaO₂/FiO₂
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	65.87±13.51	49.32±9.74^a	48.96±5.21	62.20±8.81^a	178.34±20.61	235.45±28.17^a
对照组	35	61.30±11.05	51.26±8.30^a	51.38±6.54	59.45±7.65^a	186.25±22.57	225.83±26.97^a
t值		1.521	0.879	1.664	1.367	1.493	1.427
P值		0.133	0.382	0.101	0.176	0.140	0.158

表3 两组AECOPD患者肺功能结果比较(

±s)

组　别	例数	FVC(L)		MVV(%)		FEV₁(L)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	1.20±0.29	2.05±0.41^a	34.42±3.26	50.86±5.72^a	1.12±0.25	1.81±0.38^a
对照组	35	1.25±0.27	1.73±0.35^a	34.17±3.35	42.54±4.65^a	1.16±0.23	1.42±0.33^a
t值		0.731	3.444	0.309	6.556	0.682	4.495
P值		0.467	0.001	0.758	0.000	0.497	0.000

表3 两组AECOPD患者肺功能结果比较(

±s)

组　别	例数	FVC(L)		MVV(%)		FEV₁(L)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	32	1.20±0.29	2.05±0.41^a	34.42±3.26	50.86±5.72^a	1.12±0.25	1.81±0.38^a
对照组	35	1.25±0.27	1.73±0.35^a	34.17±3.35	42.54±4.65^a	1.16±0.23	1.42±0.33^a
t值		0.731	3.444	0.309	6.556	0.682	4.495
P值		0.467	0.001	0.758	0.000	0.497	0.000

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Comparison of the effects of high-flow nasal cannula oxygen therapy and non-invasive ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with hypoxemia

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Comparison of the effects of high-flow nasal cannula oxygen therapy and non-invasive ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease complicated with hypoxemia