| 李 茉,王晓叶,佘 江,李 洺,马晓瑞,马楼艳,马 利,李海龙,赵芳红,马政权,翟佳佳.HFNC与NIV治疗合并Ⅱ型呼衰的COPD患者的临床疗效对比[J].,2023,(22):4329-4333 |
| HFNC与NIV治疗合并Ⅱ型呼衰的COPD患者的临床疗效对比 |
| Comparison of the Clinical Efficacy of HFNC and NIV in the Treatment of COPD Patients with Type II Respiratory Failure |
| 投稿时间：2023-04-23 修订日期：2023-05-19 |
| DOI：10.13241/j.cnki.pmb.2023.22.026 |
| 中文关键词: 高流量湿化治疗仪 无创辅助通气 慢性阻塞性肺疾病 Ⅱ型呼吸衰竭 |
| 英文关键词: High-flow nasal cannula Non-invasive ventilator Chronic Obstructive Pulmonary Diseases Type II respiratory failure |
| 基金项目:西安市卫生健康委员会基金项目（2020yb20） |
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| 中文摘要: |
| 摘要 目的：探讨高流量湿化治疗仪（HFNC）治疗合并Ⅱ型呼吸衰竭的慢性阻塞性肺疾病患者的临床效果及安全性。方法：选择2020 年 4 月至 2022 年 3 月就诊于我院的合并Ⅱ型呼吸衰竭的慢性阻塞性肺疾病的患者共151名。随机分为接受 HFNC治疗组和NIV治疗组（HFNC组77名，NIV组74名）。分别评估患者治疗前和治疗后1小时、24小时以及治疗结束前心率（heart rate，HR）、呼吸频率（respiratory rate，RR）、氧合指数（Oxygenation index，PaO2/FiO2）、CO2分压（arterial partial pressure of CO2，PaCO2）的变化、治疗不耐受和失败、有气管插管需求的情况、住院时间以及住院死亡率。结果：治疗后，两组各有6名患者死亡，死亡率分别为HFNC组7.8%，NIV组8.2%，组间比较差异无统计学意义（P=0.94）。两组患者治疗前后HR、RR、平均动脉压、白细胞计数、中性粒细胞百分比、C-反应蛋白、降钙素原及PaO2/FiO2、PaCO2、动脉血酸碱度均无明显统计学差异。与NIV组相比，HFNC组气道护理干预次数明显减少（4±1 vs 8±2，P<0.05），皮肤破损发生率明显降低（5.2% vs 20.3%，P<0.05），住院天数明显缩短（6±2 vs 8±2，P<0.05）。结论：HFNC治疗合并Ⅱ型呼吸衰竭的COPD 患者效果并不亚于NIV，且HFNC的安全性更高，可作为该类患者的首选通气支持治疗方式。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical effect of high flow nasal cannula (HFNC) in the treatment of patients with chronic obstructive pulmonary disease and type II respiratory failure. Methods: A total of 151 patients with COPD and type II respiratory failure treated in our hospital from April 2020 to March 2022 were selectd and randomly divided into the HFNC treatment group and non-invasive ventilator (NIV) treatment group. The changes of heart rate (HR), respiratory rate (RR), Oxygenation index (PaO2/FiO2), arterial partial pressure of CO2 (PaCO2) before and after treatment and intolerance and failure of treatment, endotracheal intubation requirements, length of hospital stay, and inpatient mortality at 1 and 24 hours after treatment and before the end of treatment were compared between two groups. Results: 151 COPD patients with type II respiratory failure (77 in HFNC group and 74 in NIV group) were enrolled in this study. No significant diffrence was found in the death rate of patients between HFNC group and NIV group (7.8% and 8.2%) (P=0.94). There was no significant difference in the HR, RR, mean arterial pressure, white blood cell counts, neutrophil percentage, c-reactive protein, procalcitonin, PaO2/FiO2, PaCO2, and blood potential of hydrogen before and after treatment between two groups. The number of airway care interventions in the HFNC group was significantly lower than that in the NIV group. Skin breakage was significantly more common in the NIV group (20.3% vs 5.2%, P<0.05). Conclusion: The therapeutic efficacy of HFNC is equal to NIV in treating COPD patients with type II respiratory failure. HFNC can be used as the preferred ventilation supportive treatment for such patients because of its high safety. |
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