高频喷射通气（HI-NPPV）治疗慢性阻塞性肺疾病急性加重期（AECOPD）合并 II 型呼吸衰竭的临床疗效。
Clinical efficacy of HI-NPPV in the treatment of AECOPD combined with severe type II respiratory failure.
机构信息
Department of Emergency, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Feb 28;49(2):266-272. doi: 10.11817/j.issn.1672-7347.2024.230329.
OBJECTIVES
Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with severe type II respiratory failure have a high probability of ventilation failure using conventional non-invasive positive pressure ventilation (NPPV). This study aims to investigate the clinical efficacy of high intensity NPPV (HI-NPPV) for the treatment of AECOPD combined with severe type II respiratory failure.
METHODS
The data of patients with AECOPD combined with severe type II respiratory failure (blood gas analysis pH≤7.25) treated with NPPV in the Second Affiliated Hospital of Chongqing Medical University from July 2013 to July 2023 were collected to conduct a retrospective case-control study. The patients were divided into 2 groups according to the inspired positive airway pressure (IPAP) used during the NPPV treatment: a NPPV group (IPAP<20 cmHO, 1 cmHO=0.098 kPa) and a HI-NPPV group (20 cmHO≤IPAP< 30 cmHO). Ninety-nine and 95 patients were included in the NPPV group and the HI-NPPV group, respectively. A total of 86 pairs of data were matched using propensity score matching (PSM) for data matching. The primary outcome indexes (mortality and tracheal intubation rate) and secondary outcome indexes [blood gas analysis pH, arterial partial pressure of oxygen (PaO) and arterial partial pressure of carbon dioxide (PaCO), adverse reaction rate, and length of hospitalization] were compared between the 2 groups.
RESULTS
The tracheal intubation rates of the NPPV group and the HI-NPPV group were 6.98% and 1.16%, respectively, and the difference between the 2 groups was statistically significant (=4.32, <0.05); the mortality of the NPPV group and the HI-NPPV group was 23.26% and 9.30%, respectively, and the difference between the 2 groups was statistically significant (=11.64, <0.01). The PaO at 24 h and 48 h after treatment of the HI-NPPV group was higher than that of the NPPV group, and the PaCO of the HI-NPPV group was lower than that of the NPPV group, and the differences were statistically significant (all <0.05). The differences of pH at 24 h and 48 h after treatment between the 2 groups were not statistically significant (both >0.05). The differences between the 2 groups in adverse reaction rate and hospitalization length were not statistically significant (both >0.05).
CONCLUSIONS
HI-NPPV can reduce mortality and tracheal intubation rates by rapidly improving the ventilation of patients with AECOPD combined with severe type II respiratory failure. This study provides a new idea for the treatment of patients with AECOPD combined with severe type II respiratory failure.
目的
慢性阻塞性肺疾病急性加重（AECOPD）合并严重 II 型呼吸衰竭患者使用常规无创正压通气（NPPV）发生通气失败的概率较高。本研究旨在探讨高强度 NPPV（HI-NPPV）治疗 AECOPD 合并严重 II 型呼吸衰竭的临床疗效。
方法
收集 2013 年 7 月至 2023 年 7 月重庆医科大学附属第二医院收治的 AECOPD 合并严重 II 型呼吸衰竭（血气分析 pH 值≤7.25）患者应用 NPPV 治疗的临床资料，进行回顾性病例对照研究。根据 NPPV 治疗时使用的吸气正压（IPAP）将患者分为 2 组：NPPV 组（IPAP<20 cmH2O，1 cmH2O=0.098 kPa）和 HI-NPPV 组（20 cmH2O≤IPAP<30 cmH2O）。NPPV 组和 HI-NPPV 组分别纳入 99 例和 95 例患者。采用倾向性评分匹配（PSM）对数据进行匹配，共匹配 86 对数据。比较两组患者的主要结局指标（病死率和气管插管率）和次要结局指标[血气分析 pH 值、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）、不良反应发生率和住院时间]。
结果
NPPV 组和 HI-NPPV 组的气管插管率分别为 6.98%和 1.16%，两组比较差异有统计学意义（=4.32，<0.05）；NPPV 组和 HI-NPPV 组的病死率分别为 23.26%和 9.30%，两组比较差异有统计学意义（=11.64，<0.01）。HI-NPPV 组治疗后 24 h 和 48 h 的 PaO2 均高于 NPPV 组，PaCO2 均低于 NPPV 组，差异均有统计学意义（均<0.05）。两组治疗后 24 h 和 48 h 的 pH 值比较差异均无统计学意义（均>0.05）。两组不良反应发生率和住院时间比较差异均无统计学意义（均>0.05）。
结论
HI-NPPV 可通过迅速改善 AECOPD 合并严重 II 型呼吸衰竭患者的通气，降低病死率和气管插管率。本研究为 AECOPD 合并严重 II 型呼吸衰竭患者的治疗提供了新的思路。
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