高流量吸氧在慢性阻塞性肺疾病合并呼吸衰竭患者中的临床价值

目的观察慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭接受有创机械通气患者采用两种序贯脱机方式(无创正压通气与无创正压通气联合高流量吸氧组)的临床疗效。方法将48例60岁以上COPD急性加重期给予有创机械通气的患者,随机分为A组(无创正压通气序贯组)25例和B组(无创正压通气联合高流量吸氧序贯组)23例。两组均给予常规基础治疗。每日对两组患者进行SBT试验联合科室治疗小组根据临床经验评估撤机。撤机后A组给予无创正压通气序贯治疗,B组给予无创正压通气联合高流量吸氧序贯治疗。记录患者一般资料和临床资料(年龄、性别、APACHEⅡ评分、基础疾病数量、SOFA评分),两组序贯治疗方式在拔管后4、8、12、24、48 h患者的生命体征及血气指标(心率、呼吸、收缩压、氧分压、二氧化碳分压),预后指标(有创正压通气使用时间、48 h内再插管率、48 h后再插管率、ICU住院时间、28 d和90 d病死率)。结果两组患者人口学和临床资料,有创机械通气使用时间,48 h内、48 h后再插管率,28 d及90 d病死率P值0.05,没有统计学差异。B组ICU住院时间低于A组,P值0.05,有统计学差异。结论无创正压通气联合高流量吸氧序贯治疗,缩短了ICU住院时间。

Clinical value of high flow oxygen in AECOPD patients with respiratory failure

Objective To observe the clinical effect of the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients complicated with respiratory failure after different Sequential off-line (noninvasive positive pressure ventilation and noninvasive positive pressure ventilation combined with high-flow oxygen group).Method 48 patients over 60 years old with AECOPD treated by invasive mechanical ventilation.Patients were divided into two groups at random:25 cases of group A (Non-invasive positive pressure ventilation sequential group) and 23 cases of group B (Non-invasive positive pressure ventilation combined with high-flow oxygen sequential group).Two groups received conventional treatment.According to daily SBT results and clinic experience,treatment team evaluated weaning.Group A treated by noninvasive positive pressure ventilation sequential therapy after weaning,Group B treated by noninvasive positive pressure ventilation combined with high flow oxygen sequencing.General information,clinical manifestation (age,sex,APACHE Ⅱ score,underlying diseases,SOFA score),vital signs and blood gas index (heart rate,breath,systolic pressure,oxygen partial pressure,partial pressure of carbon dioxide) after extubation (4 h,8 h,12 h,24 h and 48 h),prognostic index (invasive positive pressure ventilation time),reintubation rate within and after 48 hours,duration of ICU stay,28-day and 90-day mortality) were observed and recorded.Results There was no significant statistical difference in demography,clinical data,the duration of Invasive mechanical ventilation,reintubation rate within and after 48 hours,28-day and 90-day mortality between two groups (P＞0.05).Group B had a shorter duration of ICU stay than group A (P＜0.05),showing a statistical difference.Conclusion Noninvasive positive pressure ventilation combined with high-flow oxygen sequencing shortened the duration of ICU stay.