NIPPV与HFNC治疗AECOPD合并中度Ⅱ型呼吸衰竭的疗效比较
Comparison of the effects of non-invasive positive pressure ventilation and high-flow nasal cannula oxygen therapy in the treatment of AECOPD with moderate type II respiratory failure
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摘要: 目的 比较无创正压通气(non-invasive positive pressure ventilation,NIPPV)与经鼻高流量湿化氧疗(high-flow nasal cannula oxygen therapy,HFNC)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并中度Ⅱ型呼吸衰竭患者的临床疗效.方法 选取2018年9月—2020年3月徐州医科大学附属医院急诊ICU收治的68例AE-COPD合并中度Ⅱ型呼吸衰竭患者为研究对象,随机数字表法分为NIPPV组和HFNC组(n=34例),分别常规治疗基础上予NIPPV和HFNC.收集一般资料、急性生理与慢性健康评分Ⅱ(acute physiology and chronic health e-valuation,APACHEⅡ)、临床肺部感染评分(clinical pulmonary infection score,CPIS);比较2组患者治疗后2、24、48 h呼吸频率(respiration rate,RR)、心率(heart rate,HR)、平均动脉压(MAP)、二氧化碳分压(partial pressure of carbon dioxide,PaCO2)、氧分压(partial pressure of oxygen,PaO2)、乳酸(lactic acid,Lac)及舒适度指数;记录ICU住院时间;随访28 d临床结局相关指标(气管插管发生率、病死率).结果 2组患者治疗后血气分析各项指标水平均优于治疗前;与NIPPV组比较,HFNC组治疗后不同时间点RR、HR明显下降(P<0.05),MAP、PaCO2、PaO2、Lac差异均无统计学意义(P>0.05);HFNC组治疗后不同时间点舒适度指数明显高于NIPPV组(P<0.05);NIPPV组和HFNC组ICU住院时间(8.17±7.55)d vs(7.36±8.27)d、28 d气管插管率(20.59％vs 23.53％)和病死率(14.71％vs 11.76％)差异均无统计学意义(P>0.05).结论 对于AECOPD合并中度Ⅱ型呼吸衰竭(50 mmHgAbstract: objective: Comparison of the clinical effects of non-invasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with moderate type II respiratory failure.Methods: A total of 68 patients with AECOPD and moderate type II respiratory failure (arterial blood gas pH 7.25-7.35, 50mmHg0.05); The comfort index at different time points after treatment in the HFNC group was significantly higher than that in the NIPPV group (P<0.05); The length of ICU stay (8.17±7.55) days vs (7.36±8.27) days, the 28-day tracheal intubation rate (20.59% VS 23.53%) and mortality (14.71% VS 11.76%) in the NIPPV group and the HFNC group were not statistically significant (P>0.05). Conclusion: For AECOPD patients with moderate type II respiratory failure (50 mmHg
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