摘要目的 对比经鼻高流量氧疗(HFNC)和无创通气(NIV)治疗慢性阻塞性肺疾病(COPD)合并急性中度Ⅱ型呼吸衰竭的疗效,探讨HFNC治疗COPD合并呼吸衰竭的可行性.方法 回顾性分析2017年4月至2017年12月ICU收治的合并中度Ⅱ型呼吸衰竭(动脉血气pH7.25～7.35,PaCO2＞ 50 mmHg) COPD的患者.入ICU后4h内采用HFNC治疗并持续2h以上,且在第一个24 h内至少使用4h者,进入HFNC组;类似使用NIV治疗的患者为NIV组.观察两组治疗失败率(治疗期间患者更换到另一组的呼吸支持方式,或进行有创通气)及28 d病死率等指标.结果 入选82例患者,其中HFNC组39例,NIV组43例.HFNC组患者治疗失败率为28.2％,低于NIV组(39.5％),但Kaplan-Meier曲线分析两组差异无统计学意义(Log Rank检验1.228,P=0.268).HFNC组28 d病死率为15.4％,与NIV组(14％)差异无统计学意义(Log Rank检验0.049,P=0.824).HFNC组入选24h内气道护理干预次数显著低于NIV组[5(3～8)次比11(7～15)次],而入选24 h内呼吸支持时间显著长于NIV组[16(9～22)h比8(4～11)h](P均＜0.05).NIV组治疗期间鼻面部皮损发生率为20.9％,显著高于HFNC组的5.1％(P＜0.05).结论 对于COPD合并急性中度Ⅱ型呼吸衰竭,HFNC与NIV具有类似的治疗效果,且HFNC具有更好的治疗耐受性,是临床治疗COPD呼吸衰竭新的有潜力的呼吸支持方式.

abstractsObjective To compare the efficacy of high flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD) with acute-moderate type Ⅱ respiratory failure,and to explore the feasibility of HFNC in the treatment of COPD with respiratory failure.Methods Patients diagnosed with COPD with acute moderate type Ⅱ respiratory failure (Arterial blood gas pH 7.25-7.35,PaCO2＞ 50 mmHg) admitted to the ICUs from April 2017 to December 2017 were retrospectively analyzed.All patients who were treated with HFNC within the first 4 hours after the admission to the ICUs,and continued for more than 2 hours and for at least 4 hours within the first 24 hours were included in the HFNC group.Those treated with NIV in the same conditions were included in the NIV group.The end point was the failure rates of treatment (changing to respiratory support method in another group or invasive ventilation) and 28-day mortality.Results Eighty-two patients (39 in the HFNC group and 43 in the NIV group) were enrolled.The HFNC group had a treatment failure rate of 28.2％,which was lower than that of the NIV group (39.5％).However,Kaplan-Meier curve analysis showed no significant difference between the two groups (Log Rank test 1.228,P=0.268).The 28-day mortality rate in HFNC group was 15.4％,which was no different from 14％ in NIV group (Log Rank test 0.049,P=0.824).The number of airway care interventions within the first 24 hours was significantly lower in the HFNC group than in the NIV group [5 (3～8) vs.11 (7～15)],whereas the duration of respiratory support within the first 24 hours was significantly longer in the HFNC group than in the NIV group [16 (9～22) hours vs.8 (4～11) hours] (all P＜0.05).The incidence of nasal facial lesions in the NIV group was 20.9％,significantly higher than that of HFNC group (5.1％,P ＜0.05).Conclusion For COPD with acute moderate type Ⅱ respiratory failure,HFNC has similar therapeutic effects as NIV.HFNC has better therapeutic tolerance and is a new potential respiratory support method for clinical treatment of COPD with respiratory failure.