经鼻高流量湿化氧疗在慢性阻塞性肺疾病合并慢性呼吸衰竭家庭氧疗中的疗效分析

目的探讨经鼻高流量湿化氧疗(High-flow Nasal Cannula,HFNC)在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并慢性呼吸衰竭患者的长期家庭氧疗中的治疗效果。方法选取2019年3月至2019年8月在大理大学临床学院呼吸科、汕头潮南民生医院呼吸科、云南省第一人民医院呼吸与危重症医学科确诊为慢性阻塞性肺病合并慢性呼吸衰竭治疗好转出院患者87例,随访6个月,根据氧疗情况分为A组(未进行氧疗干预组,n=27),B组(常规鼻导管吸氧组,n=35)和C组(经鼻高流量湿化氧疗治疗组,n=25),观察治疗前后各项指标变化:6 min步行距离(6MWD),改良医学研究学会呼吸困难量表(MMRC),慢性阻塞性肺疾病评估测试(COPDA ssessment Test TM,CAT),动脉血PaO2、PaCO2,血常规(血红蛋白、红细胞压积),肺动脉压力,肺通气功能(FEV1、FEV1占预计值%)。结果治疗后,C组6MWD、MMRC和CAT评分改善效果均优于A、B两组(P<0.05);B组6MWD及MMRC改善效果优于A组(P<0.05),B组CAT评分与A组比较差异无统计学意义。与A组比较,C组治疗后肺动脉压、FEV1、FEV1%pre改善效果明显(P<0.05),B组FEV1%pre治疗后优于A组(P<0.05),肺动脉压、FEV1与A组比较差异无统计学意义;C组肺动脉压及FEV1%pre治疗效果明显优于B组(P<0.05)。治疗后,B、C组血液指标均优于治疗前(P<0.05),B、C组PaO2、PaCO2治疗效果明显优于A组(P<0.05),且C组优于B组(P<0.05)。结论慢性阻塞性肺疾病合并慢性呼吸衰竭患者进行长期家庭氧疗,能明显改善其生活质量、肺通气功能等;而HFNC比单纯使用低流量给氧具有更大的优势。

Analysis of the curative effect of high nasal flow humidification oxygen therapy in the home oxygen therapy of chronic obstructive pulmonary disease with chronic respiratory failure

Objective To observe and analyze the therapeutic effect of High-flow Nasal Cannula(HFNC)in long-term home oxygen therapy for patients with chronic obstructive pulmonary disease combined with chronic respiratory failure.Methods From March 2019 to August 2019,87 patients diagnosed with Chronic obstructive pulmonary disease with chronic respiratory failure in the department of respiratory sciences,clinical college of Dali University,Chaonan Minsheng Hospital of Shantou,and the First People’s Hospital of Yunnan province were selected.These patients which were treated better and discharged from the hospital,were divided into group A(no oxygen therapy intervention group,n=27),group B(conventional nasal catheter oxygen group,n=35)and group C(HFNC group,n=25)according to the way they received oxygen.The patients were followed up for 6 months to observe the changes of the indexs before and after treatment:6 min walking distance(6 MWD),improved medical research society dyspnea scale(MMRC),COPD Assessment Test TM(CAT),arterial blood PaO2,PaCO2,blood routine(hemoglobin,hematocrit),pulmonary artery pressure,pulmonary ventilation function(FEV1,FEV1%pre).Results After treatment,the improvement effects of 6 MWD,MMRC and CAT scores in group C were better than those of groups A and B(P<0.05).The improvement effect of 6 MWD and MMRC in group B was better than that of group A(P<0.05).There was no statistically significant difference in CAT scores between group A and B.Compared with group A,pulmonary artery pressure,FEV1,FEV1%pre of group C improved more significantly after treatment(P<0.05),group B FEV1%pre was better than group A(P<0.05),there was no significant difference in pulmonary artery pressure and FEV1,the treatment effect of pulmonary artery pressure and FEV1%pre in group C was significantly better than that in group B(P<0.05).After treatment,the treatment effect of PaO2 and PaCO2 in group B and C was significantly better than that of group A(P<0.05),and the treatment effect of group C was significantly better than that of group B(P<0.05).Conclusion Long-term home oxygen therapy can significantly improve the quality of life and pulmonary ventilation function in patients with chronic obstructive pulmonary disease(COPD)combined with chronic respiratory failure.HFNC has a greater advantage than simply using low flow oxygen.