摘要
目的:探讨经鼻高流量氧疗(HFNC)在慢性阻塞性肺疾病急性加重(AECOPD)伴Ⅱ型呼吸衰竭患者中的应用及其实施效果。方法:选取2018年1月-2019年8月本院急诊重症监护室(ICU)AECOPD伴Ⅱ型呼吸衰竭患者108例。按入住ICU的顺序,奇数号为A组,偶数号为B组,各54例。脱机拔管后,A组给予无创正压通气(NIPPV)治疗,B组给予HFNC治疗。比较两组氧疗开始前(T0)及氧疗后4 h(T1)、24 h(T2)、48 h(T3)的呼吸频率(RR)、血氧饱和度(SpO2)及氧合指数(PaO2/FiO2);比较两组治疗前与治疗5 d后的肺功能、治疗5 d后的舒适度、并发症、再插管率及治疗28 d病死率。结果:A组有效受试者为51例、B组有效受试者为52例。T2、T3时,两组RR均低于T0时,而SpO2及PaO2/FiO2均高于T0时(P<0.05)。治疗后,两组肺功能指标均高于治疗前(P<0.05);治疗后,B组肺功能指标均高于A组(P<0.05)。B组生理、心理精神、环境评分及舒适度总分均高于A组(P<0.05)。B组鼻与面部损伤、支气管痉挛、胃肠胀气发生率及再插管率均低于A组(P<0.05)。结论:HFNC在AECOPD伴Ⅱ型呼吸衰竭患者脱机拔管后的氧疗中具有良好的应用效果,可有效改善患者氧合和肺功能指标,降低并发症发生率及再插管率,舒适度良好,这对于有创通气脱机拔管后的氧疗具有一定的参考价值。
Objective:To investigate the application and effect of high-flow nasal cannula oxygen therapy(HFNC)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and typeⅡrespiratory failure.Method:A total of 108 patients with AECOPD and typeⅡrespiratory failure from January 2018 to August 2019 in our hospital emergency intensive care unit(ICU)were selected.According to the order of admission to ICU,the odd number as group A,the even number as group B,54 cases in each group.After extubation,group A was treated with non-invasive positive pressure ventilation(NIPPV)and group B treated with HFNC.The respiratory rate(RR),blood oxygen saturation(SpO2)and oxygenation index(PaO2/FiO2)were compared between the two groups before oxygen treatment(T0)and 4 h(T1),24 h(T2)and 48 h(T3)after oxygen treatment.The lung function before and after 5 d of treatment,comfort after 5 d of treatment,complications,reintubation rate and 28 d of treatment mortality of the two groups were compared.Result:There were 51 effective subjects in group A and 52 effective subjects in group B.At T2 and T3,RR of both groups were lower than those at T0,while SpO2 and PaO2/FiO2 were higher than those at T0(P<0.05).After treatment,the lung function indexes in both groups were higher than those before treatment(P<0.05).After treatment,the lung function indexes in group B were higher than those in group A(P<0.05).The physiology,mental,environmental and total scores of comfort in group B were higher than those in group A(P<0.05).The incidence of nasal and facial injuries,bronchospasm,gastrointestinal flatulence and reintubation rate in group B were lower than those in group A(P<0.05).Conclusion:HFNC has a good application effect in the oxygen therapy of patients with AECOPD and typeⅡrespiratory failure after extubation.It can effectively improve the indexes of oxygenation and lung function,reduce the incidence of complications and the rate of reintubation.It has a good comfort and certain reference value for the oxygen therapy aft
作者
李钧
LI Jun(Heze Municipal Hospital,Heze 274031,China)
出处
《中国医学创新》
CAS
2020年第9期9-13,共5页
Medical Innovation of China
