高流量鼻导管治疗序贯治疗慢性阻塞性肺疾病并发呼吸衰竭
Sequential treatment of chronic obstructive pulmonary disease concurrent with respiratory failure by high-flow nasal cannula therapy.
作者信息
Xu Shuo, Liu Xin
机构信息
Department of Respiratory and Critical Care Medicine, Ganzhou People's Hospital Ganzhou 341000, Jiangxi, China.
Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University Ganzhou 341000, Jiangxi, China.
出版信息
Am J Transl Res. 2021 Apr 15;13(4):2831-2839. eCollection 2021.
OBJECTIVE
To analyze the efficacy of sequential treatment with high-flow nasal cannula (HFNC) in chronic obstructive pulmonary disease (COPD) concomitant with respiratory failure.
METHODS
A total of 100 COPD patients concomitant with respiratory failure requiring invasive mechanical ventilation from June 2019 to May 2020 in our hospital were enrolled and then divided into two groups according to the random number table, with 50 in each group. Pulmonary infection control window (PIC) was used as a switching point for sequential ventilation. The control group (CNG) received non-invasive positive pressure ventilation (NIPPV), while the study group (SG) underwent HFNC. The efficacy, complications and 48 h reintubation rate of the two groups were statistically analyzed. The respiratory parameters, diaphragmatic parameters, diaphragmatic excursion during quiet breathing (DEq), diaphragmatic rapid shallow breathing index (D-RSBI), COPD score (CAT), 6-min walk test (6 MWT) score (Borg), General Comfort Questionnaire (GCQ), sputum viscosity, and serum factors were observed before intubation and after 48 hours of intubation.
RESULTS
The overall response rate (94.00%) in SG was higher than that in CNG (80.00%) ( < 0.05); SG had lower RR, PaCO and D-RSBI at 48 hours after extubation and higher PaO/FiO and DEd than CNG ( < 0.05); SG exhibited lower CAT and Borg at 48 hours after extubation and higher GCQ score than CNG ( < 0.05); SG had lower sputum viscosity at 48 hours after extubation than CNG ( < 0.05); SG showed lower ET-1, NLR and NT-proBNP levels at 48 hours after extubation than CNG ( < 0.05).
CONCLUSION
HFNC sequential therapy is effective and safe in the treatment of COPD concomitantly with respiratory failure. It can improve respiratory function and diaphragmatic function, reduce dyspnea and fatigue, reduce sputum viscosity, regulate serum factors, and make patients enjoy higher comfort.
目的
分析高流量鼻导管（HFNC）序贯治疗慢性阻塞性肺疾病（COPD）合并呼吸衰竭的疗效。
方法
选取2019年6月至2020年5月在我院收治的100例需要有创机械通气的COPD合并呼吸衰竭患者，根据随机数字表法分为两组，每组50例。以肺部感染控制窗（PIC）作为序贯通气的切换点。对照组（CNG）采用无创正压通气（NIPPV），研究组（SG）采用HFNC。对两组的疗效、并发症及48 h再插管率进行统计学分析。观察两组患者插管前及插管48 h后的呼吸参数、膈肌参数、静息呼吸时膈肌移动度（DEq）、膈肌快速浅呼吸指数（D-RSBI）、COPD评估测试（CAT）评分、6分钟步行试验（6 MWT）评分（Borg）、综合舒适度问卷（GCQ）、痰液黏稠度及血清因子。
结果
研究组的总有效率（94.00%）高于对照组（80.00%）（P<0.05）；研究组拔管后48 h的呼吸频率（RR）、动脉血二氧化碳分压（PaCO₂）及D-RSBI低于对照组，氧合指数（PaO₂/FiO₂）及DEq高于对照组（P<0.05）；研究组拔管后48 h的CAT及Borg评分低于对照组，GCQ评分高于对照组（P<0.05）；研究组拔管后48 h的痰液黏稠度低于对照组（P<0.05）；研究组拔管后48 h的内皮素-1（ET-1）、中性粒细胞与淋巴细胞比值（NLR）及N末端脑钠肽前体（NT-proBNP）水平低于对照组（P<0.05）。
结论
HFNC序贯治疗COPD合并呼吸衰竭有效且安全。它可改善呼吸功能和膈肌功能，减轻呼吸困难和疲劳，降低痰液黏稠度，调节血清因子，使患者舒适度更高。
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