摘要目的:探讨无创通气（NIV）联合经鼻高流量氧疗（HFNCO）在慢性阻塞性肺疾病（慢阻肺）机械通气患者撤机后序贯治疗中的应用价值。方法:以2018年1月至2019年12月济宁医学院附属湖西医院收治的慢阻肺急性加重（AECOPD）行有创机械通气（MV）并成功撤机患者为研究对象进行前瞻性随机对照研究。按随机数字表法分为治疗组40例，对照组33例。撤机后治疗组行NIV联合HFNCO序贯治疗，对照组单独行NIV序贯治疗。床旁超声测量患者膈肌移动度，比较两组患者治疗前、治疗后24、48、72 h平静呼吸膈肌移动度（DEq）、深呼吸膈肌移动度（DEd）、膈肌浅快呼吸指数（D-RSBI）、动脉血氧分压（PaO 2）、动脉血二氧化碳分压（PaCO 2）、再次气管插管率、28 d病死率及3 d内平均NIV治疗时间的差异。 结果:治疗前两组DEq、DEd、D-RSBI、PaO 2、PaCO 2差异均无统计学意义（均 P>0.05）；治疗24 h两组DEd均减小、D-RSBI均增大，但治疗组D-RSBI显著小于对照组[（1.33±0.56）比（1.62±0.59）次·min -1·mm -1， P=0.034]；治疗72 h治疗组DEd显著大于对照组[（41.4±8.1）比（37.8±6.0）mm]、D-RSBI显著小于对照组[（1.02±0.27）比（1.22±0.43）次·min -1·mm -1]（均 P<0.05）；治疗组平均NIV治疗时间显著小于对照组[（7.5±1.2）h比（9.3±2.6）h， P<0.01）]；各时间点2组PaO 2、PaCO 2差异均无统计学意义；2组再次气管插管率、28 d病死率差异均无统计学意义。 结论:NIV联合HFNCO序贯治疗能改善患者膈肌疲劳，促进呼吸肌力恢复，疗效优于单独NIV。

abstractsObjective:To investigate the value of non-invasive ventilation (NIV) combined with high flow nasal cannula oxygen therapy (HFNCO) in sequential treatment of patients with chronic obstructive pulmonary disease after mechanical ventilation.Methods:Chronic obstructive pulmonary disease with acute exacerbation (AECOPD) patients with invasive mechanical ventilation (MV) and successful withdrawal admitted into Huxi Affiliated Hospital of Jining Medical College from January 2018 to December 2019 were enrolled for perspective study. The patients were divided into treatment group ( n=40) and control group ( n=33) by random number table method. The treatment group was given NIV and HFNCO, the control group was given NIV treatment alone. Bedside ultrasound was used to measure the patients′ diaphragmatic motion, and the differences between the two groups of patients before treatment, 24, 48 and 72 h after treatment were compared in diaphragmatic excursions during quiet breathing (DEq), diaphragmatic excursions during deep breathing(DEd), diaphragmatic shallow fast breathing index (D-RSBI), arterial oxygen partial pressure (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), re-tracheal intubation rate, mortality rate for 28 days and average duration of NPPV treatment within 3 days. Results:There were no statistically significant differences in DEq, DEd, D-RSBI, PaO 2 and PaCO 2 between the two groups before treatment (all P>0.05). After 24 h treatment, DEd decreased in both groups, D-RSBI increased in both groups, However, D-RSBI [(1.33±0.56) vs (1.62±0.59) times·min -1·mm -1] in the treatment group was significantly lower than the control group, P=0.034. After 72 h treatment, DEd [(41.4±8.1) vs (37.8±6.0) mm] was significantly higher than the control group, D-RSBI [(1.02±0.27) vs (1.22±0.43) times·min -1·mm -1] was significantly lower than the control group (all P<0.05). The average duration of NIV treatment time [(7.5±1.2) vs (9.3±2.6) h] in the treatment group was significantly shorter than that in the control group ( P<0.01). There were no statistically significant differences in PaO 2, PCO 2, re-tracheal intubation rate and the mortality rate of 28 days. Conclusion:NIV combined with HFNCO sequential therapy can effectively relieve diaphragm fatigue and promote recovery of respiratory muscle strength, and it′s better than NIV alone.