摘要目的:探究经鼻高流量氧疗(HFNC)与无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭的价值。方法:本研究为病例对照研究，采用完全随机抽样的方法选择2020年5月2022年6月武威市人民医院收治的92例AECOPD合并Ⅱ型呼吸衰竭患者为本次研究对象。采用随机数字表法分为观察组及对照组各46例，观察组用HFNC治疗，对照组用NPPV治疗。比较2组血气分析指标、生命体征、治疗效果和安全用性。结果:2组动脉血氧分压(PaO 2)、pH值均较治疗前升高，动脉血二氧化碳分压(PaCO 2)较治疗前降低( P<0.05)，治疗后2组PaO 2、pH值和PaCO 2差异无统计学意义(均 P>0.05)，观察组PaO 2(56.85±5.51) mmHg(1 mmHg＝0.133 kPa)比(64.11±7.52) mmHg、pH值(7.25±0.21)比(7.37±0.16)、PaCO 2(68.11±5.26) mmHg比(55.55±5.29) mmHg；对照组PaO 2(57.21±5.32) mmHg比(66.25±7.11) mmHg、pH值(7.26±0.25)比(7.36±0.14)、PaCO 2(67.98±5.42) mmHg比(54.59±5.69) mmHg；2组治疗后的呼吸频率、心率均较治疗前降低(均 P<0.05)，平均动脉压均较治疗前升高(均 P<0.05)，治疗后组间呼吸频率、心率和平均动脉压比较差异无统计学意义( P>0.05)；观察组呼吸困难缓解时间(8.06±1.12) d长于对照组(6.51±1.02) d，观察组呼吸支持时间(8.69±1.20) d长于对照组(7.15±1.11) d，差异均有统计学意义(均 P<0.05)；2组治疗有效率、住院时间比较差异均无统计学意义(均 P>0.05)；观察组不良事件发生率6.52%(3/46)低于对照组39.13%(18/46)，差异有统计学意义( P<0.05)。 结论:HFNC、NPPV对于AECOPD合并Ⅱ型呼吸衰竭的治疗效果相似，相比于HFNC治疗，NPPV可缩短呼吸困难缓解及呼吸支持时间，但HFNC治疗可提升治疗安全性，降低并发症率。

abstractsObjective:To investigate the value of nasal high-flow oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type Ⅱ respiratory failure.Methods:This was a case-control study.A total of 92 patients with AECOPD combined with type Ⅱ respiratory failure admitted to Wuwei People′s Hospital from May 2020 to June 2022 were selected as the study subjects.Using complete random sampling method, the patients were divided into observation group ( n=46) and control group ( n=46), with the former treated with HFNC and the latter with NPPV.The blood gas analysis indexes, vital signs, therapeutic effect, and safety of the two groups were compared. Results:After treatment, the arterial oxygen partial pressure (PaO 2) and pH value in both groups were higher than those before treatment (observation group: PaO 2 [64.11±7.52] mmHg vs [56.85±5.51] mmHg, pH value [7.37±0.16] vs [7.25±0.21]; control group: PaO 2 [66.25±7.11] mmHg vs [57.21±5.32] mmHg, pH value [7.36±0.14] vs [7.26±0.25]); and the arterial partial pressure of carbon dioxide (PaCO 2) was lower than that before treatment (observation group: [55.55±5.29] mmHg vs [68.11±5.26] mmHg; control group: [54.59±5.69] mmHg vs [67.98±5.42] mmHg) ( P<0.05). There was no significant difference in PaO 2, pH, and PaCO 2 between the two groups after treatment ( P>0.05). After treatment, the respiratory rate and heart rate of the two groups were lower than those before treatment ( P<0.05), and the average arterial pressure of the two groups was higher than those before treatment ( P<0.05). There was no significant difference in respiratory rate, heart rate, and mean arterial pressure between the two groups after treatment ( P>0.05). The dyspnea relief time and respiratory support time of the observation group were longer than those of the control group ([8.06±1.12] d vs [6.51±1.02] d and [8.69±1.20] d vs [7.15±1.11] d respectively), with statistical significance ( P<0.05). There was no significant difference in effective rate and hospitalization time between the two groups ( P>0.05). The incidence of adverse events in observation group was lower than that in control group, with 6.52% (3/46) vs 39.13% (18/46), the difference statistically significant ( P<0.05). Conclusions:HFNC and NPPV have similar therapeutic effects on AECOPD complicated with type Ⅱ respiratory failure.Compared with HFNC, NPPV can shorten the time of dyspnea relief and respiratory support, but HFNC can improve the treatment safety and reduce the complication rate.