经鼻高流量氧疗在AECOPD合并低氧血症的应用效果-现代医学

经鼻高流量氧疗在AECOPD合并低氧血症的应用效果

单位：1. 阜阳市第五人民医院重症医学科, 安徽阜阳 236000;
2. 常熟市第一人民医院重症医学科, 江苏常熟 215500

分类号：R563.3

出版年·卷·期（页码）：2021·49·第八期（847-851）

摘要：

目的：观察经鼻高流量氧疗（high-flow nasal cannula，HFNC）在慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）合并低氧血症的疗效。方法：本研究回顾性分析了2018年1月至2019年6月入住我院重症医学科，诊断为AECOPD且合并有低氧血症（吸空气下，SaO₂<90%或PaO₂<60 mmHg）的患者94例，根据治疗方式分为对照组（n=47）和研究组（n=47），对照组患者在常规药物治疗基础上进行传统经鼻导管吸氧，研究组患者在常规药物治疗基础上进行经鼻高流量氧疗，比较两组临床疗效、血气分析指标、炎症指标、生活质量及预后。结果：两组患者基线特征包括治疗前心率、呼吸频率及血气分析结果差异均无统计学意义。治疗后，与对照组相比，研究组1 d的心率、呼吸频率及氧合指数均有显著下降，差异均有统计学意义（P<0.01），2 h的呼吸频率及氧合指数显著改善，差异均有统计学意义（P<0.01）。血清学方面，治疗后两组炎症指标低于治疗前，但研究组炎症指标下降更明显，差异有统计学意义（P<0.05）。生活质量及呼吸功能方面，与对照组相比，研究组SGRQ评分显著降低（P<0.01），6MWT增加（P<0.01），并且后期气管插管率更低（P=0.021），住院时间更短（P<0.01），但死亡率两组之间并无显著差异。结论：与传统经鼻导管吸氧相比，HFNC用于AECOPD合并低氧血症患者在提升氧合，减轻炎症反应，改善患者症状、生活质量、运动能力以及临床预后方面更优，值得临床推广。

Objective: To observe the effect of high flow nasal cannula (HFNC) oxygen therapy through nose on the efficacy of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with hypoxaemia. Methods: This study prospectively observed and analyzed 94 patients who were admitted to the respiratory department of our hospital from January 2018 to June 2019, and diagnosed as AECOPDcomplicated with hypoxaemia (when inhaling air, SaO₂<90% or PaO₂<60 mmHg). They were divided into control group (n=47) and study group (n=47) according to the mode of treatment. Patients in the control group received traditional transnasal catheter oxygen inhalation on top of conventional drug therapy. The patients in the study group were treated with HFNC oxygen therapy on the basis of conventional drug therapy. The clinical efficacy, blood gas analysis, inflammation level, quality of life and prognosis were compared between the two groups. Results: There was no significant difference in the baseline characteristics including heart rate, respiratory rate and blood gas analysis between the two groups before treatment. After treatment, the heart rate, respiratory rate and oxygenation index in the study group were significantly lower than those in the control group on the first day, and the respiratory rate and oxygenation index at 2 hours were significantly improved in the study group,the difference was statistically significant (P<0.01). In terms of serology, the indexes of inflammation in the two groups after treatment were lower than those before treatment, but the inflammatory indexes in the study group decreased more significantly, and the difference was statistically significant (P<0.05). In terms of quality of life and athletic ability, compared with the control group, the study group showed a significant decrease in SGRQ score, an increase in 6MWT, and a lower late tracheal intubation rate and shorter hospital stay (P<0.021), but there was no significant difference in mortality between the two groups. Conclusions: Compared with traditional transnasal catheter oxygen inhalation, high flow nasal cannula (HFNC) for AECOPD patients with hypoxemia is better in improving oxygenation, reducing inflammatory reaction, improving symptoms, quality of life,athletic ability and clinical prognosis, which is worthy of clinical application.

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