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经鼻高流量氧疗在AECOPD合并低氧血症的应用效果
作者:李彬彬1  潘妮芳2  张怀伟1 
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
关键词:经鼻高流量氧疗 慢性阻塞性肺疾病 低氧血症 
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.

参考文献:

[1] SORIANO J B, KENDRICK P J, PAULSON K R, et al. Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J]. The Lancet Respiratory Medicine, 2020, 8(6):585-596.
[2] DOBLER C C, FARAH M H, MORROW A S, et al. Treatment of stable chronic obstructive pulmonary disease:protocol for a systematic review and evidence map[J]. BMJ Open, 2019, 9(5):e027935.
[3] KESSLER R, PARTRIDGE M R, MIRAVITLLES M, et al. Symptom variability in patients with severe COPD:a pan European cross sectional study[J]. Eur Respir J, 2011, 37(2):264-272.
[4] BESNIER E, HOBEIKA S, NSEIR S, et al. High-flow nasal cannula therapy:clinical practice in intensive care units[J]. Ann Intensive Care, 2019, 9(1):98.
[5] 夏婧, 杨婷, 李美菊, 等.高流量氧疗降低机械通气患者拔管失败率的研究[J]. 中华急诊医学杂志, 2019, 28(11):1400-1406.
[6] 慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2017年更新版)[J]. 国际呼吸杂志, 2017, 37(4):1041-1057.
[7] YU X, ZHU G P, CAI T F, et al. Establishment of risk prediction model and risk score for in-hospital mortality in patients with AECOPD[J]. The Clinical Respiratory Journal, 2020, 14(11):1090-1098.
[8] CHATILA W, NUGENT T, VANCE G, et al. The effects of high-flow vs low-flow oxygen on exercise in advanced obstructive airways disease[J]. Chest, 2004, 126(4):1108-1115.
[9] CIRIO S, PIRAN M, VITACCA M, et al. Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation[J]. Respir Med, 2016, 118:128-132.
[10] 王健, 马新华, 李莉, 等.经鼻高流量氧疗治疗Ⅰ型呼吸衰竭的疗效分析[J]. 中国现代医学杂志, 2018, 28(14):65-70.
[11] MOLYNEAUX P L, MALLIA P, COX M J, et al. Outgrowth of the bacterial airway microbiome after rhinovirus exacerbation of chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2013, 188(10):1224-1231.
[12] 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.
[13] PARKE R L, ECCLESTON M L, MCGUINNESS S P.The effects of flow on airway pressure during nasal high-flow oxygen therapy[J]. Respir Care, 2011, 56(8):1151-1155.
[14] 陈永华, 庞世梅.经鼻高流量吸氧对AECOPD合并呼吸衰竭患者炎症因子与呼吸功能的影响[J]. 中外医学研究, 2019, 17(28):164-165.
[15] 谈定玉, 凌冰玉, 孙家艳, 等.经鼻高流量氧疗与无创正压通气比较治疗慢性阻塞性肺疾病合并中度呼吸衰竭的观察性队列研究[J]. 中华急诊医学杂志, 2018, 27(4):361-366.
[16] FRAT J P, RAGOT S, GIRAULT C, et al. Effect of non-invasive oxy-genation strategies in immunocompromised patients with severe acute respiratory failure:post-hoc analysis of a randomized trial[J]. Lancet Respiratory Med, 2016, 4:646-652.
[17] SPOLETINI G, ALOTAIBI M, BLASI F, et al. Heated humidified high flow nasal oxygen in adults:mechanisms of action and clinical implications[J]. Chest, 2015, 148(1):253-261.
[18] BOCCATONDA A, GROFF P.High-flow nasal cannula oxygenation utilization in respiratory failure[J]. Eur J Intern Med, 2019, 64:10-14.

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