摘要
目的探讨无创正压通气(NIPPV)与经鼻高流量氧疗(HFNC)2种治疗模式对慢性阻塞性肺疾病急性加重期(AECOPD)患者血气指标及临床预后指标等产生的影响,以期为临床决策的制定提供参考。方法研究招募2020年3月—2024年4月于首都医科大学附属北京世纪坛医院接受诊疗的AECOPD患者130人作为研究对象。根据随机数字表法将患者分为2组:NIPPV组与HFNC组,每组65例。NIPPV组患者在常规治疗的基础上给予NIPPV,HFNC组患者在常规治疗的基础上给予HFNC。比较2组患者治疗前及治疗24 h后的关键血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血液酸碱度(pH值)]及关键炎症标志物[C反应蛋白(CRP)、降钙素原(PCT)及白细胞计数(WBC)];比较2组患者治疗前和治疗5 d后的血钾、血钠水平;比较2组患者通气治疗时间、肺部感染发生率、再插管率、总住院时间、28 d病死率。结果治疗24 h后,2组患者PaO_(2)水平、pH值明显高于治疗前,且相较于NIPPV组,HFNC组患者PaO_(2)水平、pH值更高,差异均有统计学意义(P<0.05);2组患者PaCO_(2)水平明显低于治疗前,且相较于NIPPV组,HFNC组患者PaCO_(2)水平更低,差异有统计学意义(P<0.05)。治疗24 h后,2组患者CRP、PCT及WBC均明显低于治疗前;进一步对比分析显示,治疗后HFNC组患者的CRP、PCT及WBC显著低于NIPPV组,差异有统计学意义(P<0.05)。治疗5 d后,HFNC组患者的血钾与血钠水平均有所提升,而NIPPV组患者仅血钾水平提升;进一步分析表明,治疗后HFNC组患者的血钾水平高于NIPPV组,差异有统计学意义(P<0.05)。2组患者肺部感染发生率、再插管率及28 d病死率比较,差异均无统计学意义(P>0.05)。与NIPPV组相比,HFNC组患者通气治疗时间以及总住院时间更短,差异均有统计学意义(P<0.05)。结论AECOPD合并呼吸衰竭插管后拔管的患者应用HFNC治疗效果显著,相较于NIPPV,HFNC不仅有效改善了患者的血气指标,还可纠正电解质紊乱,值得临床推广应用。
Objective To explore the effects of two treatment modalities—non-invasive positive pressure ventilation(NIPPV)and high-flow nasal cannula(HFNC)oxygen therapy—on blood gas parameters and clinical prognosis indicators in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)after extubation,aiming to provide a reference for clinical decision-making.Methods The study recruited 130 AECOPD patients treated at Beijing Shijitan Hospital,Capital Medical University,from March 2020 to April 2024 as research participants.Patients were assigned to two groups using a random number table:the NIPPV group and the HFNC group,with 65 patients in each group.Patients in the NIPPV group received NIPPV in addition to conventional treatment,while patients in the HFNC group received HFNC in addition to conventional treatment.Key blood gas parameters(arterial partial pressure of oxygen[PaO_(2)],arterial partial pressure of carbon dioxide[PaCO_(2)],and blood pH)and key inflammatory markers(C-reactive protein[CRP],procalcitonin[PCT],and white blood cell count[WBC])were compared between the two groups before treatment and 24 hours after treatment.Serum potassium and sodium levels were compared between the two groups before treatment and 5 days after treatment.The duration of ventilation therapy,incidence of pulmonary infection,reintubation rate,total hospital stay,and 28-day mortality were compared between the two groups.Results Twenty-four hours after treatment,PaO_(2)levels and pH values were significantly higher in both groups compared to before treatment;furthermore,compared to the NIPPV group,PaO_(2)levels and pH values were higher in the HFNC group,with statistically significant differences(P<0.05).PaCO_(2)levels were significantly lower in both groups compared to before treatment;moreover,compared to the NIPPV group,PaCO_(2)levels were lower in the HFNC group,with a statistically significant difference(P<0.05).Twenty-four hours after treatment,CRP,PCT,and WBC levels were significantly lower in both groups compared to before treatment;further comparative analysis showed that CRP,PCT,and WBC levels in the HFNC group were significantly lower than those in the NIPPV group after treatment,with statistically significant differences(P<0.05).Five days after treatment,serum potassium and sodium levels increased in the HFNC group,while only serum potassium levels increased in the NIPPV group;further analysis indicated that serum potassium levels in the HFNC group were higher than those in the NIPPV group after treatment,with a statistically significant difference(P<0.05).There were no statistically significant differences between the two groups in the incidence of pulmonary infection,reintubation rate,or 28-day mortality(P>0.05).Compared to the NIPPV group,the duration of ventilation therapy and total hospital stay were significantly shorter in the HFNC group(P<0.05).Conclusion HFNC demonstrates significant therapeutic efficacy in AECOPD patients with respiratory failure after extubation.Compared to NIPPV,HFNC not only effectively improves patients'blood gas parameters but also corrects electrolyte imbalance,justifying its clinical promotion and application.
作者
李想
王建平
尚司
李燕
冯雅琪
戴缤
景田雨
Li Xiang;Wang Jianping;Shang Si;Li Yan;Feng Yaqi;Dai Bin;Jing Tianyu(Department of Respiratory and Critical Care Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《保健医学研究与实践》
2025年第5期38-43,共6页
Health Medicine Research and Practice
基金
国家重点研发计划项目(2020YFC2005404)。
关键词
无创正压通气
经鼻高流量氧疗
慢性阻塞性肺疾病急性加重期
血气指标
预后
Non-invasive positive pressure ventilation
High-flow nasal cannula oxygen therapy
Acute exacerbation of chronic obstructive pulmonary disease
Blood gas parameters
Prognosis
作者简介
第一作者:李想,E-mail:LX7435@bjsjth.cn。
