经鼻高流量湿化氧疗联合机械通气对慢阻肺合并呼吸衰竭患者动脉血气、疗效及预后的影响

摘要/Abstract

摘要： 目的：探讨经鼻高流量湿化氧疗(HFNC)联合机械通气(NIMV)对慢性阻塞性肺疾病合并呼吸衰竭患者动脉血气、疗效及预后的影响。方法：选取2019年5月至2020年12月我院收治的100例慢性阻塞性肺疾病合并呼吸衰竭患者，按照随机数字表法分为NIMV组及HFNC+NIMV组，每组各50例。分别于治疗前和治疗后采用血气分析仪检测患者pH、PaO2、PaCO2血气指标，肺功能检测仪检测患者FEV1、PEF、FEV1/FVC水平，并对患者的治疗有效率进行对比，分析患者在1年后的生存情况。结果：治疗前，两组患者PaO2、PaCO2指标比较，差异无统计学意义（P>0.05）；治疗后，与NIMV组比较，HFNC+NIMV组患者PaO2更高，PaCO2更低（P<0.05）。治疗前，两组患者FEV1、PEF、FEV1/FVC水平比较差异无统计学意义（P>0.05）；治疗后，与NIMV组比较，HFNC+NIMV组患者FEV1、FEV1/FVC更高，PEF更低（P<0.05）。与NIMV组比较，HFNC/NIMV组患者临床治疗总有效率更高（P<0.05）。NIMV组患者的1年内生存率为74.00％（37例/50例），HFNC+NIMV组患者1年内生存率为96.00％（48例/50例），组间比较差异有统计学意义（P<0.05）。结论：慢性阻塞性肺疾病合并呼吸衰竭患者通过采用NIMV联合HFNC方式进行治疗，可提高患者的肺功能、血气指标水平，提高患者预后生存率，临床治疗效果显著。

关键词: font-size:medium, ">慢性阻塞性肺疾病合并呼吸衰竭；经鼻高流量湿化氧疗；机械通气；动脉血气；疗效

Abstract: Objective： To investigate the effect of nasal high-flow humidifyied oxygen(HFNC) therapy combined with mechanical ventilation(NIMV) on arterial blood gas indexes， curative effect and prognosis of patients with chronic obstructive emphysema(COPD) complicated with respiratory failure. Methods： 100 patients with COPD complicated with respiratory failure admitted to our hospital from May 2019 to December 2020 were selected and divided into two groups according to random number table method which were the mask type non-invasive NIMV group and the HFNC+NIMV group， with 50 cases in each group. Blood gas analyzer was used to detect blood gas indexes pH， PaO2 and PaCO2 before and after treatment， and lung function detector was used to detect FEV1， PEF and FEV1/FVC levels of the patients， and the treatment effective rate of patients was compared， and the survival of patients after 1 year was analyzed. Results： Before treatment， there was no significant difference in PaO2 and PaCO2 indexes between the two groups (P>0.05). After treatment， PaO2 was higher and PaCO2 was lower in HFNC+NIMV group than those in NIMV group (P<0.05). Before treatment， there was no difference in FEV1， PEF and FEV1/FVC level between the two groups (P>0.05). After treatment， compared with NIMV group， FEV1 and FEV1/FVC levels were higher and PEF was lower in HFNC+NIMV group (P<0.05).Compared with NIMV group， the total effective rate of HFNC+NIMV group was higher(P<0.05). The 1 year survival rate of the NIMV group was 74.00% (37 cases /50 cases)， and that of the HFNC+NIMV group was 96.00% (48 cases /50 cases)， and the difference between the two groups was statistically significant (P<0.05). Conclusion： The treatment of COPD complicated with respiratory failure by NIMV combined with HFNC can improve the lung function and blood gas indexes of patients， which is of great significance for improving the prognosis and survival rate of patients， and the clinical therapeutic effect is remarkable.

Key words: font-size:medium, ">Chronic obstructive pulmonary disease complicated with respiratory failure； Nasal high-flow humidified oxygen therapy； Mechanical ventilation； Arterial blood gas indexes； Efficacy

中图分类号:

方树青, 汪东. 经鼻高流量湿化氧疗联合机械通气对慢阻肺合并呼吸衰竭患者动脉血气、疗效及预后的影响[J]. 中国医药导刊, 2023, 25(5): 538-542.

FANG Shuqing, WANG Dong. Effects of Nasal High-Flow Humidified Oxygen Therapy Combined with Mechanical Ventilation on Arterial Blood Gas Indexes， Curative Effect and Prognosis of Patients with COPD Complicated with Respiratory Failure[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2023, 25(5): 538-542.

参考文献

[1]Qin K， Xu B，P ang M， et al. The functions of CD4 T-helper lymphocytes in chronic obstructive pulmonary disease[J]. Acta Biochim Biophys Sin (Shanghai)， 2022， 54(2)：173-178.
     [2]丁惠卿，李英姿，赵莹，等. 无创机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭患者的临床治疗效果分析[J]. 中国社区医师，2021，37(28)：22-23.
     [3]党苗苗，蔺敏.头孢呋辛钠联合经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的效果及对患者MMP-9、TIMP-1水平的影响[J]. 临床医学研究与实践，2022，7(17)：87-90.
     [4]中华医学会，中华医学会杂志社，中华医学会全科医学分会，等. 慢性阻塞性肺疾病基层诊疗指南(2018年)[J]. 中华全科医师杂志，2018，17(11)：856-870．
     [5]包秀萍.呼吸衰竭的临床诊断与治疗[J]. 中国现代药物应用，2016， 10(3)：150-151.
     [6]Li L， Yan J， Ma L Q， et al. Effects of maxingloushi decoction on immune inflammation and programmed death markers in mice with chronic obstructive pulmonary disease[J]. World J Emerg Med， 2022， 13(1)：32-37.
     [7]Ceruti S， Roncador M， Saporito A， et al. Low PEEP mechanical ventilation and PaO2/FiO2 ratio evolution in COVID-19 patients[J]. SN Compr Clin Med， 2021， 3(12)：2435-2442.
     [8]Song Y， Zhang J， Xing J， et al. Comparison of high-flow nasal oxygen cannula therapy versus a standard oxygen face mask in patients with hypostatic pneumonia.[J]. J Int Med Res.2021， 49(6)：3000605211022279.
     [9]李宁，卢春兰，蒋碧佳.经鼻高流量氧疗与无创正压通气治疗老年慢阻肺合并Ⅱ型呼吸衰竭的临床研究[J]. 川北医学院学报， 2020， 35(3)：489-492.
     [10]Alkouh R， Rhalete AE， Manal M， et al. High-flow nasal oxygen therapy decrease the risk of mortality and the use of invasive mechanical ventilation in patients with severe SARS-CoV-2 pneumonia? A retrospective and comparative study of 265 cases[J]. Ann Med Surg (Lond)， 2022， 74(1)：103230.
     [11]李淑静，任素霞，郭志丽，等. 经鼻高流量湿化氧疗对慢阻肺合并呼吸衰竭患者炎症反应、血气指标及肺功能的影响[J]. 武警后勤学院学报(医学版)，2021，30(10)：107-109.
     [12]李飞，张骞云，宫艳格，等. 湿化经鼻高流量氧疗对肺癌手术患者呼吸功能的影响[J]. 现代肿瘤医学，2020，28(8)：1301-1303.
     [13]Ospina-Tascón GA， Calderón-Tapia LE， García AF， et al. Effect of high-flow oxygen therapy vs conventional oxygen therapy on invasive mechanical ventilation and clinical recovery in patients with severe COVID-19： a randomized clinical trial[J]. JAMA， 2021， 326(21)：2161-2171.
     [14]Perepelitsa SA， Kuzovlev A. High-frequency ventilation in the treatment of acute respiratory failure[J]. Physical and Rehabilitation Medicine Medical Rehabilitation， 2021， 12(8)：125-134.
     [15]Shafi′I MNA， EI-Din DMK， Ismaiel MAA， et al. Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure[J]. QJM： An International Journal of Medicine， 2021， 27(10)：1012-1025.

快速检索引用检索图表检索高级检索