| 摘要: |
| ［摘要］ 目的 比较经鼻高流量氧疗（HFNC）与无创正压通气（NIPPV）治疗慢性阻塞性肺疾病急性加重（AECOPD）合并Ⅱ型呼吸衰竭患者的临床疗效，分析HFNC治疗AECOPD合并Ⅱ型呼吸衰竭患者失败的影响因素。方法 选择2018-01～2019-12该院重症医学科收治的AECOPD合并Ⅱ型呼吸衰竭患者120例，以随机数字表法将其分为HFNC组和NIPPV组，每组60例。比较两组治疗前后呼吸频率（RR）、降钙素原（PCT）、动脉血气分析相关指标、急性生理学与慢性健康状况评估Ⅱ（APACHE Ⅱ）评分、序贯器官衰竭评估（SOFA）评分的变化情况。比较两组治疗后72 h液体平衡量、非有创机械通气时间、有创机械通气率和有创机械通气时间。采用多因素Logistic回归分析影响HFNC治疗失败的因素。结果 与治疗前比较，治疗后HFNC组和NIPPV组的RR、动脉血二氧化碳分压（PaCO2）、PCT、APACHE Ⅱ评分和SOFA评分均显著降低（P<0.05），而动脉血氧分压(PaO2)和氧合指数显著上升（P<0.05）。但上述指标在治疗前后的两组间比较差异均无统计学意义（P>0.05）。在治疗过程中，两组72 h液体平衡量、非有创机械通气时间、有创机械通气率和有创机械通气时间比较差异无统计学意义（P>0.05）。单因素分析结果显示，HFNC治疗成功组和HFNC治疗失败组在入院时的RR、氧合指数、APACHE Ⅱ评分、SOFA评分、72 h液体平衡量方面比较差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，较高水平的入院RR和72 h液体平衡量是HFNC治疗AECOPD患者失败的危险因素(P<0.05)。结论 HFNC与NIPPV均可有效改善AECOPD合并Ⅱ型呼吸衰竭患者RR及血气指标。较高水平的入院RR和72 h液体平衡量是HFNC治疗AECOPD患者失败的危险因素。 |
| 关键词: 慢性阻塞性肺疾病急性加重 经鼻高流量氧疗 无创正压通气 影响因素 |
| DOI：10.3969/j.issn.1674-3806.2020.10.10 |
| 分类号:R 459.6 |
| 基金项目:甘肃省武威市列科技计划项目（编号：WW1902012） |
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| Comparative analysis of clinical efficacy of high-flow nasal cannula oxygen therapy and non-invasive positive pressure ventilation in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure |
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LU Hu-qiang, WANG Fang, WANG Jing-cheng, et al.
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Department of Critical Care Medicine, Wuwei People′s Hospital, Gansu 733000, China
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| Abstract: |
| ［Abstract］ Objective To compare the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC) and non-invasive positive pressure ventilation(NIPPV) in treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with type Ⅱ respiratory failure, and to analyze the influencing factors of failure of HFNC in treatment of AECOPD complicated with type Ⅱ respiratory failure. Methods One hundred and twenty patients with AECOPD complicated with type Ⅱ respiratory failure admitted to the Department of Critical Care Medicine of Wuwei People′s Hospital from January 2018 to December 2019 were selected and divided into HFNC group and NIPPV group by random number table method, with 60 cases in each group. The changes in respiratory rate(RR), procalcitonin(PCT), arterial blood gas analysis related indexes, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores and Sequential Organ Failure Assessment(SOFA) scores were compared between the two groups before and after treatment. The 72-hour fluid balance volume, non-invasive mechanical ventilation time, invasive mechanical ventilation rate and invasive mechanical ventilation time were compared between the two groups after treatment. Multivariate Logistic regression analysis was used to analyze the factors influencing the treatment failure of HFNC. Results Compared with those before treatment, the RR, partial pressure of carbon dioxide in arterial blood(PaCO2), PCT, APACHE Ⅱ scores and SOFA scores were significantly decreased(P<0.05), while the partial pressure of oxygen in arterial blood(PaO2) and oxygenation indexes were significantly increased in the HFNC group and the NIPPV group after treatment(P<0.05), but the above indicators were not significantly different between the two groups before and after treatment(P>0.05). During treatment, there were no significant differences in the 72-hour fluid balance volume, non-invasive mechanical ventilation time, invasive mechanical ventilation rate and invasive mechanical ventilation time between the two groups(P>0.05). The results of univariate analysis showed that there were statistically significant differences in the RR, oxygenation index, APACHE Ⅱ scores, SOFA scores, and 72-hour fluid balance volume between the HFNC treatment success group and the HFNC treatment failure group at admission(P<0.05). The results of multivariate Logistic regression analysis showed that higher level of RR at admission and 72-hour fluid balance volume were the risk factors of failure of HFNC in treatment of AECOPD patients(P<0.05). Conclusion Both HFNC and NIPPV treatments can effectively improve RR and blood gas indexes in patients with AECOPD complicated with type Ⅱ respiratory failure. Higher level of RR at admission and 72-hour fluid balance volume are the risk factors of failure of HFNC in treatment of AECOPD patients. |
| Key words: Acute exacerbation of chronic obstructive pulmonary disease(AECOPD) High-flow nasal cannula oxygen therapy(HFNC) Non-invasive positive pressure ventilation(NIPPV) Influencing factors |
