切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2019, Vol. 12 ›› Issue (02) : 104 -108. doi: 10.3877/cma.j.issn.1674-6880.2019.02.006

所属专题: 文献

论著

经鼻高流量氧疗与无创正压通气交替治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者的临床研究
余优琴1, 诸葛建成2,(), 王春林2, 刘吉庆2, 汪芬华2, 叶燕飞2   
  1. 1. 324002 浙江衢州,衢州市中医医院护理部
    2. 324002 浙江衢州,衢州市中医医院ICU
  • 收稿日期:2018-10-10 出版日期:2019-04-01
  • 通信作者: 诸葛建成
  • 基金资助:
    衢州市2016年度指导性科技项目(2016100)

Effect of high-flow nasal cannulae and non-invasive positive pressure ventilation alternately on chronic obstructive pulmonary disease patients complicated with type Ⅱ respiratory failure

Youqin Yu1, Jiancheng Zhuge2,(), Chunlin Wang2, Jiqing Liu2, Fenhua Wang2, yanfei Ye2   

  1. 1. Department of Nursing, Quzhou Municipal Hospital of TCM, Quzhou 324002, China
    2. Department of Intensive Care Unit, Quzhou Municipal Hospital of TCM, Quzhou 324002, China
  • Received:2018-10-10 Published:2019-04-01
  • Corresponding author: Jiancheng Zhuge
  • About author:
    Corresponding author: Zhuge-Jiancheng, Email:
引用本文:

余优琴, 诸葛建成, 王春林, 刘吉庆, 汪芬华, 叶燕飞. 经鼻高流量氧疗与无创正压通气交替治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者的临床研究[J/OL]. 中华危重症医学杂志(电子版), 2019, 12(02): 104-108.

Youqin Yu, Jiancheng Zhuge, Chunlin Wang, Jiqing Liu, Fenhua Wang, yanfei Ye. Effect of high-flow nasal cannulae and non-invasive positive pressure ventilation alternately on chronic obstructive pulmonary disease patients complicated with type Ⅱ respiratory failure[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(02): 104-108.

目的

探讨经鼻高流量氧疗(HFNC)与无创正压通气交替治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的临床疗效。

方法

将衢州市中医医院ICU收治的90例COPD伴Ⅱ型呼吸衰竭的患者分为观察组(45例)和对照组(45例)。对照组患者在常规治疗基础上实施无创正压通气治疗,观察组患者在常规治疗基础上实施HFNC-无创正压通气交替治疗。比较两组患者的治疗有效率、住院时间、气管插管率、28 d病死率、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、pH值、呼吸频率、心率以及痰液黏稠度等。

结果

治疗后,观察组患者治疗有效率(91.1% vs. 73.3%,χ2= 4.865,P= 0.027)、PaO2 [(79 ± 15)mmHg vs.(69 ± 14)mmHg,t= 3.006,P= 0.003]及pH值[(7.53 ± 1.01)vs.(7.04 ± 1.06),t= 2.245,P= 0.027]均较对照组显著升高;而观察组患者ICU住院时间[(8.6 ± 1.6)d vs.(10.4 ± 2.5)d,t= 4.091,P < 0.001]、气管插管率(6.7% vs. 24.4%,χ2= 5.414,P= 0.020)、PaCO2 [(52 ± 13)mmHg vs.(70 ± 13)mmHg,t= 6.564,P < 0.001]、呼吸频率[(77 ± 8)次/min vs.(88 ± 9)次/min,t= 6.310,P < 0.001]及心率[(17.6 ± 3.0)次/min vs.(19.0 ± 2.9)次/min,t= 2.238,P= 0.028]均较对照组显著降低。观察组患者治疗后痰液黏稠度Ⅰ度20例、Ⅱ度13例、Ⅲ度12例,对照组患者治疗后痰液黏稠度Ⅰ度9例、Ⅱ度15例、Ⅲ度21例,两组患者治疗后痰液黏稠度比较,差异有统计学意义(χ2= 3.876,P= 0.049)。

结论

对COPD合并Ⅱ型呼吸衰竭的患者,运用HFNC与无创正压通气交替疗法是一种新的有潜力的呼吸支持方式。

Objective

To explore the clinical effect of high-flow nasal cannulae (HFNC) and non-invasive positive pressure ventilation alternately on chronic obstructive pulmonary disease (COPD) patients with type Ⅱ respiratory failure.

Methods

Totally 90 patients of COPD complicated with type Ⅱ respiratory failure were divided into the observation group (45 cases) and control group (45 cases) in the Department of Intensive Care Unit, Quzhou Municipal Hospital of TCM. The patients in the control group were treated with non-invasive positive pressure ventilation on the basis of routine treatment, and the patients in the observation group were alternately treated with HFNC-non-invasive positive pressure ventilation on the basis of routine treatment. The therapeutic effective rate, hospital stay, tracheal intubation rate, 28-day mortality, partial pressure of carbon dioxide in arterial (PaCO2), arterial partial pressure of oxygen (PaO2), pH value, respiratory rate, heart rate and sputum viscosity were compared between these two groups.

Results

After treatment, in the observation group, the effective rate (91.1% vs. 73.3%, χ2 = 4.865, P = 0.027), PaO2 [(79 ± 15) mmHg vs. (69 ± 14) mmHg, t = 3.006, P = 0.003] and pH value [(7.53 ± 1.01) vs. (7.04 ± 1.06), t = 2.245, P = 0.027)] were significantly higher, while the hospital stay of ICU [(8.6 ± 1.6) d vs. (10.4 ± 2.5) d, t = 4.091, P < 0.001], tracheal intubation rate (6.7% vs. 24.4%, χ2 = 5.414, P = 0.020), PaCO2 [(52 ± 13) mmHg vs. (70 ± 13) mmHg, t = 6.564, P < 0.001], respiratory rate [(77 ± 8) breaths/min vs. (88 ± 9) breaths/min, t = 6.310, P < 0.001] and heart rate [(17.6 ± 3.0) beats/min vs. (19.0 ± 2.9) beats/min, t= 2.238, P= 0.028] were significantly lower than those in the control group. There were 20 cases of degree Ⅰ sputum viscosity, 13 cases degree Ⅱ and 12 cases degree Ⅲ in the observation group after treatment, and 9 cases degree Ⅰ, 15 cases degree Ⅱ and 21 cases degree Ⅲ in the control group after treatment. There was significant difference in the sputum viscosity between these two groups (χ2= 3.876, P= 0.049).

Conclusion

The alternative therapy of HFNC and non-invasive positive pressure ventilation is a new potential respiratory support method for COPD patients complicated with type Ⅱ respiratory failure.

表1 两组COPD伴Ⅱ型呼吸衰竭患者治疗前后PaO2、PaCO2、pH值、呼吸频率及心率比较(±s
1
曹云.重症呼吸衰竭的危险因素及护理对策分析[J].中国现代药物应用,2013,7(15):176-177.
2
中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
3
何小军,王勇,郭伟.日本呼吸病学协会无创正压通气指南(第二次修订版)[J].中华急诊医学杂志,2017,26(7):735-738.
4
许群锋,倪慧萍.无创正压通气联合雾化吸入对慢性阻塞性肺疾病加重期患者的疗效分析[J/CD].中华危重症医学杂志(电子版),2018,11(4):244-249.
5
Stefan MS, Nathanson BH, Higgins TL, et al. Comparative effectiveness of noninvasive and invasive ventilation in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Crit Care Med, 2015, 43(7):1386-1394.
6
Fricke K, Tatkov S, Domanski U, et al. Nasal high flow reduces hypercapnia by clearance of anatomical dead spacein a COPD patient[J]. Respir Med Case Rep, 2016 (19):115-117.
7
魏文举,夏金根,石妮,等.湿化高流量鼻导管吸氧在成人患者中的应用进展[J].护士进修杂志,2015,30(23):2141-2145.
8
岳伟岗,张志刚,张彩云,等.经鼻高流量氧疗对呼吸衰竭患者疗效的Meta分析[J].中华危重病急救医学,2017,29(5):396-402.
9
Parke RL, Eccleston ML, McGuinness SP. The effects of flow on airway pressure during nasal high-flow oxygen therapy[J]. Respir Care, 2011, 56(8):1151-1155.
10
张宇,张小辉,卢富明.吸入乙酰半胱氨酸治疗COPD的疗效及对痰液黏稠度、气道阻力的影响[J].解放军预防医学杂志,2018,36(9):1134-1137.
11
吕姗,安友仲.主动温湿化的经鼻高流量氧疗在成人患者中的应用[J].中华危重病急救医学,2016,28(1):84-88.
12
谈定玉,凌冰玉,孙家艳,等.经鼻高流量氧疗与无创正压通气比较治疗慢性阻塞性肺疾病合并中度呼吸衰竭的观察性队列研究[J].中华急诊医学杂志,2018,27(4):361-366.
13
Nagata K, Morimoto T, Fujimoto D, et al. Efficacy of high-flow nasal cannula therapy in acute hypoxemic respiratory failure: decreased use of mechanical ventilation[J]. Respir Care, 2015, 60(10):1390-1396.
14
Itagaki T, Okuda N, Tsunano Y, et al. Effect of high-flow nasal cannula on thoraco-abdominal synchrony in adult critically ill patients[J]. Respir Care, 2014, 59(1):70-74.
15
Spoletini G, Alotaibi M, Blasi F, et al. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications[J]. Chest, 2015, 148(1):253-261.
16
Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects[J]. Respir Care, 2016, 61(4):529-541.
17
刘荣.高流量湿化氧疗治疗慢性阻塞性肺疾病的效果观察[J].中国医药导刊,2014,16(1):170-171.
18
李海泉,赵杰,贾晓民.呼吸湿化治疗仪在慢阻肺合并CAP患者中的应用效果分析[J].临床肺科杂志,2018,23(2):260-262.
19
邹晓月,韩慧,包芸,等.慢性阻塞性肺疾病急性加重期患者有创-无创序贯治疗中无创通气时长的临床研究[J/CD].中华危重症医学杂志(电子版),2018,11(5):357-360.
20
Brotfain E, Zlotnik A, Schwartz A, et al. Comparison of the effectiveness of high flow nasal oxygen cannula vs. standard non-rebreather oxygen face mask in post-extubation intensive care unit patients[J]. Isr Med Assoc J, 2014, 16(11):718-722.
[1] 张烈, 严一核, 杜洁瑜. 分泌型白细胞蛋白酶抑制因子对无创呼吸机治疗重症肺炎患者的预测效能[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 301-306.
[2] 赵小欢, 尚志英, 段文超, 张晓燕, 孙东强. 无创通气治疗COPD 并发呼吸衰竭不同预后患者外周血MicroRNA及炎性因子水平分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 777-780.
[3] 马锦芳, 何正光, 郑劲平. 盐酸氨溴索雾化吸入治疗慢性阻塞性肺疾病黏痰症患者的疗效和安全性分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 568-574.
[4] 程炜炜, 张青, 张诚实, 冯契靓, 陈荣荣, 赵云峰. 全身免疫炎症指数与慢性阻塞性肺疾病急性加重期病情严重程度相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 580-584.
[5] 杨万荣, 任治坤, 时新颍. 沙丁胺醇雾化吸入脾多肽治疗AECOPD的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 609-612.
[6] 赖乾德, 吕相琴, 蔺洋, 刘媛梅, 赵春艳, 李琦. 肝素结合蛋白对慢性阻塞性肺疾病预后预测分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 613-616.
[7] 王微, 丁霖, 陈茜, 呼延欣, 闫蓓. 综合治疗对慢性阻塞性肺疾病的疗效及转归影响分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 621-624.
[8] 方晓玉, 王婷, 赵珊, 陈锋. HALP指数对AECOPD并发呼吸衰竭患者ICU结局的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 639-641.
[9] 刘娟娟, 李志华. 风险预警对无创呼吸机治疗肺心病并发呼吸衰竭的作用[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 645-647.
[10] 郭少琳, 郭建英, 左秀萍, 高苗. 慢性阻塞性肺疾病康复训练依从性影响因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 652-654.
[11] 白若靖, 郭军. 维生素D对肺部疾病临床意义的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 659-662.
[12] 孔令梅, 徐晓媛, 马丽颖. 慢性阻塞性肺疾病认知衰弱危险因素及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 407-410.
[13] 袁广琴, 朱珠, 林云霞. 胸腺肽联合无创正压通气救治AECOPD并发Ⅱ型呼吸衰竭患者的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 438-441.
[14] 李海亮, 俞云, 张星星, 陈管洁, 刘玲, 谢剑锋, 常炜. 经鼻高流量氧疗在危重症患者气管插管过程中效果的荟萃分析[J/OL]. 中华重症医学电子杂志, 2024, 10(03): 227-235.
[15] 何秀, 敖的, 杨郑, 林小华. 改良呼吸支持策略对慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者的疗效[J/OL]. 中华卫生应急电子杂志, 2024, 10(03): 140-144.
阅读次数
全文


摘要