经鼻高流量氧疗治疗慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭的临床疗效观察_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

王翠 ¹ ,  施敏骅 ²

1. ;
2. ;

Corresponding author：

施敏骅, Email: shiminhua@163.com

Keywords：

经鼻高流量氧疗; 慢性阻塞性肺疾病; 呼吸衰竭; 高碳酸血症

DOI：

10.7507/1671-6205.202101041

Video：

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目的探讨经鼻高流量氧疗（HFNC）治疗慢性阻塞性肺疾病（简称慢阻肺）急性加重合并Ⅱ型呼吸衰竭的临床疗效。方法选取2017年1月至2019年3月昆山市第三人民医院收治的慢阻肺急性加重合并Ⅱ型呼吸衰竭患者的病例资料进行回顾性分析，共108例。在标准治疗的基础上根据给氧方式分成HFNC组（33例）、无创正压机械通气（NPPV）组（35例）和低流量氧疗组（40例）。观察三组患者治疗前后动脉血气指标、生命体征指标和不良反应，比较三组治疗模式临床转归的差异。结果 HFNC组和NPPV组治疗后的血气分析（PaO₂、PaCO₂及pH）、心率、气管插管率、生活质量评价等指标上显著优于低流量氧疗组，HFNC组和NPPV组平均住院时间均短于低流量氧疗组，HFNC组治疗后的心率、呼吸频率、腹腔胀气、颜面部压伤、鼻黏膜干燥和出血等显著优于NPPV组及低流量氧疗组，差异有显著统计学意义（P<0.05）。结论对于治疗慢阻肺急性加重合并Ⅱ型呼吸衰竭的患者，HFNC和NPPV均有较好的临床效果。HFNC具有不良反应少、患者耐受性好等特点，在慢阻肺急性加重合并Ⅱ型呼吸衰竭治疗中值得推广应用。

Citation： 王翠, 施敏骅. 经鼻高流量氧疗治疗慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭的临床疗效观察. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(11): 807-812. doi: 10.7507/1671-6205.202101041 Copy

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13.	Roca O, Hernández G, Díaz-Lobato S, et al. Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure. Crit Care, 2016, 20(1): 109-121.
14.	Bräunlich J, Seyfarth HJ, Wirtz H. Nasal High-flow versus non-invasive ventilation in stable hypercapnic COPD: a preliminary report. Multidiscip Respir Med, 2015, 10(1): 27.
15.	Alotaibi NM, Chen V, Hollander Z, et al. Phenotyping COPD exacerbations using imaging and blood-based biomarkers. Int J Chron Obstruct Pulmon Dis, 2018, 13: 217-229.
16.	Fawzy A, Putcha N, Paulin LM, et al. Association of thrombocytosis with COPD morbidity: The SPIROMICS and COPDGene cohorts. Respir Res, 2018, 19(1): 20.
17.	Plotnikow GA, Thille AW, Vasquez DN, et al. Effects of high-flow nasal cannula on end-expiratory lung impedance in semi-seated healthy subjects. Respir Care, 2018, 63(8): 1016-1023.
18.	Bräunlich J, Beyer D, Mai D, et al. Effects of nasal high flow on ventilation in volunteers, COPD and idiopathic pulmonary fibrosis patients. Respiration, 2013, 85(4): 319-325.
19.	Avison M, Watson M, Wockner L, et al. Paediatric high-flow nasal cannula therapy in children with bronchiolitis: A retrospective safety and efficacy study in a non-tertiary environment. Emerg Med Australas, 2017, 29(2): 198-203.
20.	Sun J, Li Y, Ling B, et al. High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: an observational cohort study. Int J Chron Obstruct Pulmon Dis, 2019, 5(14): 1229-1237.

1. Singh D, Agusti A, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. Eur Respir J, 2019, 53(5): 1900164.
2. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J, 2017, 50: 1602426.
3. Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med, 2015, 372(23): 2185-2196.
4. Porhomayon J, El-Solh AA, Pourafkari L, et al. Applications of nasal high-flow oxygen therapy in critically ill adult patients. Lung, 2016, 194(5): 705-714.
5. Zhao H, Wang H, Sun F, et al. High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: A systematic review and meta-analysis. Crit Care, 2017, 21(1): 184.
6. Parke RL, McGuinness SP, Eccleston ML. A preliminary randomized controlled trial to assess effectiveness of nasal high flow oxygen in intensive care patients. Respir Care, 2011, 56(3): 265-270.
7. Caarratala PJM, Llorens P, Brouzet B, et al. High-flow therapy via nasal cannula in acute heart failure. Rev Cardiol, 2011, 62(8): 723-725.
8. Mauri T, Wang YM, Dalla Corte F, et al. Nasal high flow: physiology, efficacy and safety in the acute care setting, a narrative review. Open Access Emerg Med, 2019, 11: 109-120.
9. Pisani L, Astuto M, Prediletto I, et al. High flow through nasal cannula in exacerbated COPD patients: a systematic review. Pulmonology, 2019, 25: 348-354.
10. 中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识. 中华结核和呼吸杂志, 2019, 42(2): 83-91.
11. Groves N, Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care, 2007, 20(4): 126-131.
12. Möller W, Celik G, Feng S, et al. Nasal high flow clears anatomical dead space in upper airway models. J Appl Physiol (1985), 2015, 118(12): 1525-1532.
13. Roca O, Hernández G, Díaz-Lobato S, et al. Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure. Crit Care, 2016, 20(1): 109-121.
14. Bräunlich J, Seyfarth HJ, Wirtz H. Nasal High-flow versus non-invasive ventilation in stable hypercapnic COPD: a preliminary report. Multidiscip Respir Med, 2015, 10(1): 27.
15. Alotaibi NM, Chen V, Hollander Z, et al. Phenotyping COPD exacerbations using imaging and blood-based biomarkers. Int J Chron Obstruct Pulmon Dis, 2018, 13: 217-229.
16. Fawzy A, Putcha N, Paulin LM, et al. Association of thrombocytosis with COPD morbidity: The SPIROMICS and COPDGene cohorts. Respir Res, 2018, 19(1): 20.
17. Plotnikow GA, Thille AW, Vasquez DN, et al. Effects of high-flow nasal cannula on end-expiratory lung impedance in semi-seated healthy subjects. Respir Care, 2018, 63(8): 1016-1023.
18. Bräunlich J, Beyer D, Mai D, et al. Effects of nasal high flow on ventilation in volunteers, COPD and idiopathic pulmonary fibrosis patients. Respiration, 2013, 85(4): 319-325.
19. Avison M, Watson M, Wockner L, et al. Paediatric high-flow nasal cannula therapy in children with bronchiolitis: A retrospective safety and efficacy study in a non-tertiary environment. Emerg Med Australas, 2017, 29(2): 198-203.
20. Sun J, Li Y, Ling B, et al. High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: an observational cohort study. Int J Chron Obstruct Pulmon Dis, 2019, 5(14): 1229-1237.

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经鼻高流量氧疗治疗慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭的临床疗效观察

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