经鼻高流量氧疗在高原地区慢性阻塞性肺疾病急性加重合并呼吸衰竭患者中的应用

目的探讨经鼻高流量氧疗（HFNC）在高原地区慢性阻塞性肺疾病急性加重（AECOPD）合并呼吸衰竭患者中的使用效果。 方法回顾性分析青海省人民医院重症医学科收住的40例AECOPD合并呼吸衰竭患者，根据治疗方式不同分为治疗组和对照组，每组各20例。两组患者根据病情需要给予控制感染、解除支气管、稀释痰液等对症治疗，治疗组在此基础上应用HFNC，对照组应用常规低流量氧疗。比较两组患者的一般资料、治疗前和治疗24 h后的呼吸频率、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、pH值、痰液黏稠度、氧疗成功情况及不良反应发生情况。 结果治疗后，治疗组患者呼吸频率（15.5 ± 1.6）次/min vs.（18.8 ± 1.6）次/min，t = 6.612，P = 0.001]和PaCO₂ （49.4 ± 4.3）mmHg vs.（56.2 ± 4.6）mmHg，t = 4.848，P = 0.001]均较对照组显著降低，PaO₂ （61.1 ± 2.8）mmHg vs.（57.4 ± 3.3）mmHg，t = 3.798，P = 0.001]和pH值（7.38 ± 0.03）vs.（7.36 ± 0.03），t = 2.108，P = 0.042]均较对照组显著升高；且治疗组患者治疗后呼吸频率（15.5 ± 1.6）次/min vs.（23.1 ± 1.9）次/min，t = 23.194，P = 0.001]和PaCO₂ （49.4 ± 4.3）mmHg vs.（62.2 ± 4.5）mmHg，t = 20.176，P = 0.001]均较同组治疗前显著降低，PaO₂ （61.1 ± 2.8）mmHg vs.（45.5 ± 3.9）mmHg，t = 29.705，P = 0.001]和pH值（7.38 ± 0.03）vs.（7.32 ± 0.03），t = 6.325，P< 0.001]均较同组治疗前显著升高。对照组患者治疗前痰液黏稠度Ⅰ度4例、Ⅱ度8例、Ⅲ度8例，治疗后痰液黏稠度Ⅰ度5例、Ⅱ度7例、Ⅲ度8例；治疗组患者治疗前痰液黏稠度Ⅰ度3例、Ⅱ度8例、Ⅲ度9例，治疗后痰液黏稠度Ⅰ度10例、Ⅱ度8例、Ⅲ度2例。治疗后治疗组患者痰液黏稠度较对照组明显稀薄（H = 2.163，P = 0.031），且治疗组患者治疗后痰液黏稠度较同组治疗前明显稀薄（H = 2.824，P = 0.005）。此外，治疗组患者HFNC氧疗成功情况较对照组显著升高（17/20 vs. 11/20，χ² = 4.286，P = 0.038），而不良反应发生情况较对照组明显下降（5/20 vs. 12/20，χ² = 5.013，P = 0.025）。 结论HFNC对于高原地区AECOPD合并呼吸衰竭患者疗效显著，可显著改善患者的呼吸频率和血气情况，有效稀释痰液，降低痰液黏稠度，并能提高患者的舒适度，降低氧疗时的不良反应，减少无创通气使用，缩短住院天数。

Effect of high-flow nasal cannula oxygen therapy on patients with acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure in plateau areas

ObjectiveTo investigate the effect of high-flow nasal cannula oxygen therapy (HFNC) for the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure in plateau areas. MethodsA total of 40 patients with AECOPD and respiratory failure in the Qinghai Provincial People's Hospital were retrospectively analyzed. They were divided into the treatment group and control group, with 20 cases in each group. According to their condition, all patients were given symptomatic treatment such as controlling infection, relieving bronchus and diluting sputum. On this basis, patients in the treatment group were treated with HFNC, while those in the control group were treated with the routine low-flow nasal cannula. The general data, respiratory frequency, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), pH value, sputum viscosity, success of oxygen therapy and occurrence of adverse reactions of patients were compared between the two groups before and 24 h after treatment. ResultsAfter treatment, the respiratory frequency (15.5 ± 1.6) breaths/min vs. (18.8 ± 1.6) breaths/min, t = 6.612, P = 0.001] and PaCO₂ (49.4 ± 4.3) mmHg vs. (56.2 ± 4.6) mmHg, t = 4.848, P = 0.001] were significantly lower, and PaO₂ (61.1 ± 2.8) mmHg vs. (57.4 ± 3.3) mmHg, t = 3.798, P = 0.001)] and pH value (7.38 ± 0.03) vs. (7.36 ± 0.03), t = 2.108, P = 0.042] were significantly higher in the treatment group than in the control group. In the treatment group, the respiratory frequency (15.5 ± 1.6) breaths/min vs. (23.1 ± 1.9) breaths/min, t = 23.194, P = 0.001] and PaCO₂ (49.4 ± 4.3) mmHg vs. (62.2 ± 4.5) mmHg, t = 20.176, P = 0.001] were significantly lower, while PaO₂ (61.1 ± 2.8) mmHg vs. (45.5 ± 3.9) mmHg, t = 29.705, P = 0.001] and pH value (7.38 ± 0.03) vs. (7.32 ± 0.03), t = 6.325 P < 0.001] were significantly higher after treatment than before treatment. In the control group, there were 4 cases of sputum viscosity degree Ⅰ, 8 cases of degree Ⅱ, and 8 cases of degree Ⅲ before treatment, and there were 5 cases of sputum viscosity degree Ⅰ, 7 cases of degree Ⅱ and 8 cases of degree Ⅲ after treatment. In the treatment group, there were 3 cases of sputum viscosity degree Ⅰ, 8 cases of degree Ⅱ, and 9 cases of degree Ⅲ before treatment, and there were 10 cases of sputum viscosity degree Ⅰ, 8 cases of degree Ⅱ, and 2 cases of degree Ⅲ after treatment. The sputum viscosity of the treatment group after treatment was significantly thinner than that of the control group (H = 2.163, P = 0.031) and that before treatment (H = 2.824, P = 0.005). In addition, compared with the control group, the success of HFNC in the treatment group was significantly higher (17/20 vs. 11/20, χ² = 4.286, P = 0.038), while the incidence of adverse reactions decreased significantly (5/20 vs. 12/20, χ² = 5.013, P = 0.025). ConclusionsThe HFNC has a remarkable curative effect on the AECOPD patients complicated with respiratory failure in plateau areas. It can obviously improve their respiratory frequency and blood gas condition, effectively dilute the sputum and reduce the sputum viscosity. It can also add comfort, decrease adverse reactions during oxygen therapy and non-invasive ventilation use, and shorten hospital stays of patients.