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经鼻高流量氧疗在慢性阻塞性肺疾病急性加重无创正压通气间歇期应用的探索性研究

Exploratory study on the application of nasal high-flow oxygen therapy during breaks off noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease

摘要:

目的:对比经鼻高流量氧疗(HFNC)和鼻导管氧疗(NCO)在慢性阻塞性肺疾病急性加重(AECOPD)无创通气(NIV)间歇期的治疗效果,探讨NIV联合HFNC治疗AECOPD的可行性。方法:2017年8月至2019年7月ICU收治的AECOPD合并Ⅱ型呼吸衰竭(动脉血气pH<7.35,PaCO 2 > 50 mmHg)并使用NIV的患者,按1:1随机(随机数字法)被分为HFNC组和NCO组。HFNC组在NIV间歇期接受HFNC治疗,NCO组在NIV间歇期接受低流量NCO治疗。主要观察终点为呼吸支持总时间。次要观察终点为住院期间气管插管率、NIV治疗期和间歇期时间、ICU住院时间及总住院时间等。 结果:82例患者进入随机分组,经二次排除后HFNC组和NCO组分别有36例和37例纳入分析。HFNC组呼吸支持总时间为(74±18) h,显著低于NCO组(93±20) h( P=0.042)。HFNC组NIV治疗期总时间为(36±11) h,显著低于NCO组(51±13) h( P=0.014)。HFNC组平均单个NIV间歇期时间与NCO组差异无统计学意义,但从第三个NIV间歇期开始HFNC组显著长于NCO组( P<0.05)。HFNC组和NCO气管插管率分别为13.9%和18.9%,两组差异无统计学意义( P=0.562)。HFNC组ICU住院时间为(4.3±1.7) d,低于NCO组的(5.8±2.1) d( P=0.045),而两组总住院时间差异无统计学意义。NIV间歇期NCO组心率、呼吸频率、经皮二氧化碳分压及呼吸困难评分显著高于HFNC组,而舒适度评分亦低于HFNC组( P均<0.05)。 结论:对于接受NIV治疗的AECOPD患者,在NIV间歇期给予HFNC较NCO可以缩短呼吸支持时间及ICU住院时间,改善NIV间歇期二氧化碳潴留及呼吸困难。HFNC是AECOPD患者NIV治疗的理想补充工具。

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abstracts:

Objective:To compare the therapeutic effects of nasal high-flow oxygen therapy (HFNC) and nasal canal oxygenation (NCO) during breaks off non-invasive ventilation (NIV) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore the feasibility of NIV combined with HFNC in the treatment of AECOPD.Methods:From August 2017 to July 2019, AECOPD patients with type Ⅱrespiratory failure (arterial blood gas pH <7.35, PaCO 2 > 50 mmHg) who were treated with NIV were randomly (random number) assigned to the HFNC group and NCO group at 1:1. The HFNC group received HFNC treatment during breaks from NIV and the NCO group received low-flow NCO during the NIV interval. The primary endpoint was the total respiratory support time. The secondary endpoints were endotracheal intubation, duration of NIV treatment and breaks from NIV, length of ICU stay, total length of hospital stay and so on. Results:Eighty-two patients were randomly assigned to the HFNC group and the NCO group. After secondary exclusion, 36 patients in the HFNC group and 37 patients in the NCO group were included in the analysis. The total respiratory support time in the HFNC group was significantly shorter than that in the NCO group [(74 ± 18) h vs. (93 ± 20) h, P = 0.042]. The total duration of NIV treatment in the HFNC group was significantly shorter than that in the NCO group [(36 ± 11) h vs. (51 ± 13) h, P=0.014]. There was no significant difference of the mean duration of single break from NIV between the two groups, but durations of break from NIV in the HFNC group were significantly longer than those in the NCO group since the third break from NIV ( P < 0.05). The intubation rates of the HFNC and NCO groups were 13.9% and 18.9%, respectively, with no significant difference ( P=0.562). The length of ICU stay in the HFNC group was (4.3 ± 1.7) days, which was shorter than that in the NCO group [(5.8 ± 2.1) days, P=0.045], but there was no significant difference in the total length of hospital stay between the two groups. Heart rate, respiratory rate, percutaneous carbon dioxide partial pressure and dyspnea score during the breaks from NIV in the NCO group were significantly higher than those in the HFNC group, and the comfort score was lower than that in the HFNC group ( P<0.05). Conclusion:For AECOPD patients receiving NIV, compared with NCO, HFNC during breaks from NIV can shorten respiratory support time and length of ICU stay, and improve carbon dioxide retention and dyspnea. HFNC is an ideal complement to NIV therapy in AECOPD patients.

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作者: 谈定玉 [1] 徐艳 [1] 王云云 [1] 徐军 [2] 王兵侠 [1] 曹鹏 [1] 单雪芹 [1] 朱庆程 [1] 耿平 [1]
期刊: 《中华急诊医学杂志》2020年29卷8期 1046-1052页 ISTICPKUCSCDCA
栏目名称: 呼吸危重症
DOI: 10.3760/cma.j.issn.1671-0282.2020.08.005
发布时间: 2020-09-28
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