摘要
目的:探讨经鼻高流量湿化氧疗和无创正压通气对慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭气管插管拔管后治疗的短期效果及不良事件发生情况。方法:选择南平市建阳第一医院2021年1月—2023年1月收治的70例慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭行机械通气治疗并拔除气管插管患者,按随机数字表法分为对照组和观察组,每组35例。对照组采取无创正压通气治疗,观察组采取经鼻高流量湿化氧疗治疗。比较两组血气指标(动脉血氧分压、动脉血二氧化碳分压、氧合指数),呼吸频率、心率、平均动脉压,炎症因子(白细胞介素-6及肿瘤坏死因子-α),再次插管率、气管切开率,不良事件及死亡发生情况。结果:观察组治疗24 h后的动脉血氧分压、氧合指数分别为(80.39±2.56)、(325.25±14.88)mmHg,均明显高于治疗前[(56.95±2.93)、(257.22±20.46)mmHg]及对照组治疗24 h后[(74.45±3.50)、(300.78±15.55)mmHg](P<0.05);观察组治疗24 h后动脉血二氧化碳分压为(58.70±6.04)mmHg,明显低于治疗前(74.60±5.09)mmHg及对照组治疗24 h后(65.22±5.92)mmHg(P<0.05)。治疗24 h后观察组呼吸频率、心率分别为(21.1±3.15)、(78.28±4.28)次/min,均明显低于治疗前[(32.4±4.20)、(107.00±6.33)次/min]及对照组治疗24 h后[(26.4±3.95)、(87.22±4.41)次/min],差异均有统计学意义(P<0.05)。观察组治疗72 h后的白细胞介素-6、肿瘤坏死因子-α分别为(5.41±0.14)、(10.82±0.33)ng/L,均明显低于治疗前[(8.12±0.36)、(18.58±0.54)ng/L]及对照组治疗72 h后[(6.84±0.24)、(13.07±0.26)ng/L],差异均有统计学意义(P<0.05)。观察组再次插管率、气管切开率及死亡率与对照组比较,差异均无统计学意义(P>0.05)。观察组不良事件总发生率为15.63%(5/32),明显低于对照组的77.42%(24/31),差异有统计学意义(P<0.05)。结论:经鼻高流量湿化氧疗应用于慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭气管插管拔管后能够更好地
Objective:To investigate the short-term effect and adverse events of nasal high flow humidification oxygen therapy in the treatment of tracheal intubation and extubation in chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure.Method:A total of 70 patients with chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure treated with mechanical ventilation and tracheal intubation removed from Jianyang First Hospital of Nanping from January 2021 to January 2023 were selected and divided into control group and observation group according to random number table method,with 35 cases in each group.The control group was treated with non-invasive positive ventilation,and the observation group was treated with nasal high flow humidification oxygen therapy.Blood gas indexes(arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide,oxygenation index),respiratory rate,heart rate and mean arterial pressure,inflammatory factors(interleukin-6 and tumor necrosis factor-α),reintubation rate,tracheotomy rate and the occurrence of adverse events and death were compared between the two groups.Result:The arterial partial pressure of oxygen and oxygenation index of the observation group respectively was(80.39±2.56)and(325.25±14.88)mmHg after 24 h of treatment,which were significantly higher than before treatment[(56.95±2.93),(257.22±20.46)mmHg]and control group[(74.45±3.50),(300.78±15.55)mmHg]after 24 h of treatment(P<0.05).The arterial partial pressure of carbon dioxide in the observation group was(58.70±6.04)mmHg after 24 h of treatment,which was significantly lower than before treatment[(74.60±5.09)mmHg]and control group[(65.22±5.92)mmHg]after 24 h treatment(P<0.05).After 24 h of treatment,the respiratory rate and heart rate of the observation group respectively was(21.1±3.15)and(78.28±4.28)times/min,which were significantly lower than before treatment[(32.4±4.20),(107.00±6.33)times/min]and control group[(26.4±3.95),(87.22±4.41)times/min]aft
作者
杨武
YANG Wu(Jianyang First Hospital of Nanping,Fujian Province,Nanping 354200,China)
出处
《中国医学创新》
CAS
2023年第25期94-98,共5页
Medical Innovation of China
关键词
慢性阻塞性肺疾病
Ⅱ型呼吸衰竭
气管插管
经鼻高流量湿化氧疗
无创正压通气
Chronic obstructive pulmonary disease
Type Ⅱ respiratory failure
Tracheal intubation
Nasal high flow humidification oxygen therapy
Non-invasive positive ventilation
