经鼻加温湿化高流量氧疗与无创辅助通气治疗慢性阻塞性肺疾病的临床效果分析

目的比较经鼻加温湿化高流量氧疗（HFNC）与无创辅助通气（NIV）治疗慢性阻塞性肺疾病急性加重（AECOPD）伴Ⅱ型呼吸衰竭病人的临床效果。方法选择77例COPD病人，随机分为观察组（n=39）和对照组（n=38）。观察组采用HFNC，对照组采用NIV，2组病人均予抗感染、解痉平喘、化痰等综合治疗。比较2组治疗前后的动脉血气分析指标、COPD评估测试评分（CAT）、肺功能指标及失败率。结果2组治疗后24 h二氧化碳分压（PaCO₂）、氧分压（PaO₂）分别低于和高于治疗前（P < 0.05），治疗后72 h PaCO₂、PaO₂分别低于和高于治疗前及治疗后24 h（P < 0.05）；2组间治疗前后pH、PaCO₂、PaO₂差异均无统计学意义（P>0.05）。2组治疗后失败率、CAT评分、肺功能指标（FEV1、FVC及FEV1/FVC）及失败原因（治疗不耐受、血气指标恶化、临床症状加重）差异均无统计学意义（P>0.05）。结论HFNC与NIV在治疗AECOPD伴Ⅱ型呼吸衰竭病人中疗效类似。

Analysis of the clinical effects of heated humidified high-flow nasal cannula and non-invasive ventilation in the treatment of chronic obstructive pulmonary disease

ObjectiveTo compare the clinical effects between high-flow nasal cannula(HFNC) and non-invasive ventilation(NIV) in the treatment of acute exacerbations of chronic obstructive pulmonary disease(AECOPD) complicated with type Ⅱ respiratory failure.MethodsSeventy-seven patients with COPD were randomly divided into the observation group(39 cases) and control group(38 cases).The observation group and control group were treated with HFNC and NIV, respectively.Two groups were treated with anti-inflammatory, spasmolysis, asthma and phlegm of comprehensive treatment.The blood gas analysis, CAT score, lung function and failure rate in two groups were compared between before and after treatment.ResultsThe PaCO₂ and PaO₂ in two groups after 24 h of treatment were lower higher than those before treatment(P < 0.05), and the PaCO₂ and PaO₂ after 72 h of treatment were lower and higher than those before treatment and after 24 h of treatment, respectively(P < 0.05).There was no statistical significance in the levels of pH, PaCO₂ and PaO₂ in two groups between before and after treatment(P>0.05).After treatment, the differences of the failure rate, CAT score, pulmonary function indexes(including the FEV1, FVC and FEV1/FVC) and failure causes(including treatment intolerance, deterioration of blood gas indexes and exacerbation of clinical symptoms) were not statistically significant between two groups(P>0.05).ConclusionsThe effects of HFNC and NIV in the treatment of AECOPD with type Ⅱ respiratory failure are similar.