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经鼻高流量湿化氧疗和无创正压通气在慢性阻塞性肺疾病急性加重期Ⅱ型呼吸衰竭合并呼吸肌疲劳患者中的疗效比较

High-flow nasal cannula oxygen therapy versus non-invasive positive pressure ventilation in treating patients with acute exacerbation of chronic obstructive pulmonary disease type Ⅱ respiratory failure complicated with respiratory muscle fatigue

    摘要
  • 摘要:
      目的  比较经鼻高流量湿化氧疗（HFNC）和无创正压通气（NPPV）在治疗慢性阻塞性肺疾病急性加重期（AECOPD）Ⅱ型呼吸衰竭合并呼吸肌疲劳患者中的疗效。
      方法  选取AECOPD Ⅱ型呼吸衰竭住院患者90例，按辅助呼吸肌动用评分法分为A组46例（轻度呼吸肌疲劳）和B组44例（重度呼吸肌疲劳）。根据随机数字表法随机将A组分为A1组24例（HFNC治疗）、A2组22例（NPPV治疗）；将B组分为B1组19例（HFNC治疗）、B2组25例（NPPV治疗）。比较4组患者治疗前后动脉血氧分压pa（O2）、动脉血氧二氧化碳分压pa（CO2）、辅助呼吸肌动用评分、平静呼吸膈肌移动度（DEq）及用力呼吸膈肌移动度（DEd）；比较4组插管率及换组率。
      结果  治疗24、48 h后，4组pa（O2）高于治疗前，pa（CO2）低于治疗前，差异有统计学意义（P < 0.05）；B2组pa（O2）高于B1组，pa（CO2）低于B1组，差异有统计学意义（P < 0.05）。治疗24、48 h后，B2组辅助呼吸肌动用评分较治疗前降低，差异有统计学意义（P < 0.05），B2组较B1组评分降低，差异有统计学意义（P < 0.05）。治疗48 h后，4组DEq大于治疗前，DEd小于治疗前，差异有统计学意义（P < 0.05）；B2组DEq大于B1组，DEd小于B1组，差异有统计学意义（P < 0.05）。B1组插管率高于B2组，差异有统计学意义（P < 0.05）。4组换组率比较，差异无统计学意义（P>0.05）。
      结论  HFNC和NPPV在治疗AECOPD Ⅱ型呼吸衰竭合并轻度呼吸肌疲劳患者时疗效相似；在治疗合并重度呼吸肌疲劳患者时，NPPV疗效优于HFNC。

     

    Abstract:
      Objective  To compare efficacy of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) type Ⅱ respiratory failure complicated with respiratory muscle fatigue.
      Methods  A total of 90 hospitalized patients with AECOPD type Ⅱ respiratory failure were divided into group A (46 cases, mild respiratory muscle fatigue) and group B (44 cases, severe respiratory muscle fatigue) according to auxiliary respiratory muscle utilization score. Group A was randomly divided into group A1 (n=24, HFNC treatment) and group A2 (n=22, NPPV treatment), and group B was divided into group B1 (n=19, HFNC treatment) and group B2 (n=25, NPPV treatment) according to random number table method. Arterial partial pressure of oxygen pa(O2), arterial partial pressure of oxygen carbon dioxidepa(CO2), auxiliary respiratory muscle mobilization score, diaphragm excursion during quite breathing (DEq) and diaphragm excursion during deep breathing (DEd) were compared before and after treatment in four groups; intubation rate and group change rate were compared among the four groups.
      Results  After 24 and 48 hours of treatment, pa(O2) in four groups was significantly higher than treatment before, and pa(CO2) was significantly lower than treatment before (P < 0.05); pa(O2)in the group B2 was significantly higher than that in the group B1, and pa(CO2) was significantly lower than that in the group B1 (P < 0.05). After 24 and 48 hours of treatment, the score of assisted respiratory muscle utilization in the group B2 was significantly lower than that before treatment, and was significantly lower in the group B2 than that in the group B1 (P < 0.05). After 48 hours of treatment, DEq in four groups was significantly higher than before treatment, and was significantly lower than before treatment (P < 0.05). DEq in the group B2 was significantly higher, and was significantly lower than that in the group B1 (P < 0.05). The intubation rate in the group B1 was significantly higher than that in the group B2 (P < 0.05). There was no significant difference in the change rate among the four groups (P>0.05).
      Conclusion  HFNC and NPPV have similar efficacy in the treatment of patients with AECOPD type Ⅱ respiratory failure complicated with mild respiratory muscle fatigue. The efficacy of NPPV is superior to HFNC in treating patients with severe respiratory muscle fatigue.

     

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