Application of high flow nasal cannula oxygen therapy in elderly patients with acute exacerbation of chronic obstructive pulmonary disease and type Ⅱ respiratory failure
Application of high flow nasal cannula oxygen therapy in elderly patients with acute exacerbation of chronic obstructive pulmonary disease and type Ⅱ respiratory failure
王晶 1唐娜1
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作者信息
1. 首都医科大学宣武医院急诊科,北京 100053
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摘要
目的 研究经鼻高流量氧疗(HFNC)对老年慢性阻塞性肺疾病急性加重期(AECOPD)伴Ⅱ型呼吸衰竭患者的治疗效果.方法 选择2022年1月至12月首都医科大学宣武医院急诊科收治的96例老年AECOPD伴Ⅱ型呼吸衰竭患者,随机分为观察组49例和对照组47例.对照组在常规抗炎、平喘治疗的基础上给予无创正压通气(NPPV)治疗,观察组患者常规抗炎、平喘治疗基础上给予HFNC治疗.比较两组患者治疗前后的pH值、动脉氧分压(PaO2)和动脉二氧化碳分压(PaCO2)的水平.应用调查问卷评估两组患者治疗舒适度.随访28 d,比较两组患者治疗后误吸、胃胀气等并发症发生率、气管插管率及病死率.结果 两组治疗后pH值和PaO2较前升高,PaCO2较前降低(P＜0.05),但两组间pH值、PaO2和PaCO2比较差异无统计学意义(P＞0.05).调查问卷显示观察组舒适度评分高于对照组(3.57±0.71 vs 2.46±0.83,t=7.020,P＜0.01),并发症发生率低于对照组(10.20％vs 27.65％,x2=4.798,P＜0.05),两组患者气管插管率和病死率差异无统计学意义(P＞0.05).结论 HFNC同NPPV在老年AECOPD伴Ⅱ型呼吸衰竭患者中具有相近的治疗效果,但HFNC并发症较少,舒适程度高.
Abstract
Objective To investigate the therapeutic effect of high flow nasal cannula oxygen therapy(HFNC)on elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and type Ⅱ respiratory failure.Methods A total of 96 elderly AECOPD patients with type 2 respiratory failure who received treatment at Xuanwu Hospital Capital Medical University from January to December 2022 were selected and divided into observation group(n=49)and control group(n=47)randomly.On the basis of conventional anti-inflammatory and antiasthmatic treatment,control group was treated with non-invasive positive pressure ventilation(NPPV),observation group was treated with HFNC.The level of pH value,arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbon dioxide(PaCO2)before and after treatment were compared between two groups.The treatment comfort was evaluated with questionnaires.After 28 days of follow-up,the incidence of complications such as aspiration,bloating,tracheal intubation rate and mortality rate were compared between two groups.Results After treatment,pH value and PaO2 increased,and PaCO2 decreased in both group(P＜0.05).However,there was no significant difference in pH,PaO2 and PaCO2 between two groups after treatment(P＞0.05).The score of comfort degree of the observation group was higher than that of the control group(3.57±0.71 vs 2.46±0.83,t=7.020,P＜0.01),and the complication rate was lower than that of the control group(10.20％vs 27.65％,x2=4.798,P＜0.05).There was no significant difference between the two groups in the tracheal intubation rate and mortality rate(P＞0.05).Conclusion NPPV and HFNC have similar therapeutic effect in elderly AECOPD patients with type 2 respiratory failure,but HFNC has fewer complications and higher degree of comfort.
维普
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