摘要目的:观察双水平正压无创通气(BIPAP)-低流量序贯氧疗吸入对老年慢性阻塞性肺疾病急性加重(AECOPD)患者的临床疗效。方法:前瞻性非随机对照研究，采用目的抽样方法选取2017年2月至2022年2月在武警北京市总队医院收治的AECOPD患者135例，根据治疗方案分为2组，BIPAP-低流量序贯氧疗(BIPAP)组70例，低流量氧气吸入(LFOI)组65例采用经鼻导管低流量氧气吸入。检测2组治疗前后肺功能相关指标[第1秒用力呼气量(FEV 1)、肺活量(VC)、FEV 1占用力肺活量比率(FEV 1/FVC)]、血气分析[动脉血氧分压(PaO 2)、动脉二氧化碳分压(PaCO 2)、动脉氢离子浓度(pH)]、血清炎症指标[白细胞介素6(IL-6)、C反应蛋白(CRP)]及预后评分[慢性阻塞性肺疾病评估(CAT)量表、急性生理与慢性健康评估(APACHE)Ⅱ]等的变化情况。 结果:BIPAP组70例，男48例，女22例，年龄(68.9±4.1)岁；LFOI组65例，男42例，女23例，年龄(68.7±4.0)岁；2组性别、年龄、吸烟史、病程、糖尿病、高血压和冠心病等基础疾病比例差异均无统计学意义(均 P>0.05)；2组患者的VC、FEV 1、FEV 1/FVC、PaO 2、pH均随时间延续呈现逐渐上升趋势，但BIPAP组上升更多，而PaCO 2随时间延续呈现逐渐降低的趋势，但BIPAP组降低更多，2组组间、时点间、组间和时点间交互作用差异均有统计学意义(均 P<0.05)。2组患者IL-6、CRP均呈现随时间延续逐渐降低的趋势。2组IL-6降低的幅度一致，但CRP幅度不同，BIPAP组降低更多，2组IL-6在组间、时点间差异均有统计学意义( F值分别为14.62、621.01，均 P<0.001)，CRP在组间、时点间、组间和时点间交互作用差异均有统计学意义( F值分别为31.40、229.00、7.55，均 P<0.001)。治疗前2组CAT、APACHE Ⅱ评分比较差异无统计学意义( t值分别为0.92、0.05， P值分别为0.359、0.964)。出院时2组CAT、APACHE Ⅱ评分较治疗前比较均有下降( P<0.05)，且治疗后，BIPAP组的CAT[(14.87±4.54)分比(16.49±3.67)分]、APACHE Ⅱ评分[(14.23±3.27)分比(15.31±2.56)分]均低于LFOI组( t值分别为2.27、2.13， P值分别为0.025、0.035)。 结论:BIPAP-低流量序贯氧疗的应用可有效改善AECOPD患者的肺呼吸功能，提高血氧含量，维持机体酸碱平衡，且患者预后较好，较单纯使用低氧流量持续吸入获益更多。

abstractsObjective:To observe the clinical curative effect of bi-level positive airway pressure (BIPAP)-low flow sequential oxygen therapy in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:In the prospective non-random control study, 135 patients with AECOPD admitted to Beijing Armed Police Corps Hospital were enrolled by purposive sampling method between February 2017 and February 2022.According to different treatment methods, they were divided into BIPAP group(70 cases, BIPAP-low flow sequential oxygen therapy) and low-flow oxygen inhalation (LFOI) group (65 cases, transnasal tube LFOI). Changes in pulmonary function related indexes (forced expiratory volume in 1 second [FEV 1], vital capacity [VC], FEV 1/forced vital capacity [FEV 1/FVC]), blood gas analysis indexes (partial pressure of arterial oxygen [PaO 2], partial pressure of arterial carbon dioxide [PaCO 2], arterial hydrogen ion concentration [pH]), serum inflammatory indexes (interleukin [IL]-6, C-reactive protein [CRP])and prognosis (COPD Assessment Test [CAT], acute physiological and chronic health assessment [APACHE] II) before and after treatment in the two groups were detected. Results:In BIPAP group, there were 48 males and 22 females, with age of (68.9±4.1) years.In LFOI group, there were 42 males and 23 females, with age of (68.7±4.0) years.There was no significant difference in gender, age, smoking history, course of disease or proportions of underlying diseases (diabetes mellitus, hypertension, and coronary heart disease) between the two groups ( P>0.05). With time passing, VC, FEV 1, FEV 1/FVC, PaO 2, and pH were gradually increased in both groups, with the increase more significant in BIPAP group.However, PaCO 2 was gradually decreased, with the decreased more significant in BIPAP group.There were significant differences in the above indexes in terms of inter-group dimension, time points dimension, and interaction dimension ( P<0.05). With time passing, IL-6 and CRP were gradually decreased in both groups.The decrease of IL6 was the same in the two groups, but the decrease of CRP was more significant in BIPAP group.There were significant differences in IL-6 in terms of inter-group dimension and time points dimension ( F=14.62, 621.01, P<0.001), and there were significant differences in CRP in terms of inter-group dimension, time points dimension, and interaction dimension ( F=31.40, 229.00, 7.55, P<0.001). Before treatment, there was no significant difference in CAT and APACHE Ⅱ scores between the two groups ( t=0.92, 0.05, P=0.359, 0.964). At discharge, CAT and APACHE Ⅱ scores were decreased in both groups ( P<0.05). After treatment, scores of CAT ([14.87±4.54]points vs [16.49±3.67]points)and APACHE Ⅱ ([14.23±3.27]points vs [15.31±2.56]points)in BIPAP group were lower than those in LFOI group ( t=2.27, 2.13, P=0.025, 0.035). Conclusions:BIPAP-low flow sequential oxygen therapy can effectively improve pulmonary respiratory function in AECOPD patients, increase blood oxygen content, and maintain acid-base balance, with better prognosis and more benefits compared with LFOI alone.