经鼻高流量氧疗与无创正压通气在慢性阻塞性肺疾病急性加重期治疗中的效果比较
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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急性加重期(AECOPD)的疗效,探讨HFNC治疗AECOPD的可行性。方法回顾性分析82例中度(Ⅱ级)AECOPD患者,其中43例使用HFNC呼吸支持治疗,39例使用NIV呼吸支持治疗,观察两组治疗临床缓解率及动脉血二氧化碳分压(PaCO_2)、氧合指数等指标。结果全组患者治疗前与治疗后72 h PaCO_2[(58.6±10.6)mmHg vs(46.1±9.4)mmHg,P=0.016]及氧合指数[(149.3±20.8)mmHg vs(200.8±20.6)mmHg,P=0.024]均有改善,差异有统计学意义;而分组治疗,HFNC组与NIV组患者治疗后24 h的PaCO_2和氧合指数,72 h的PaCO_2和氧合指数,两组间差异无统计学意义(P>0.05)。HFNC组治疗第3、5、7天临床缓解率分别6.98%、34.88%及62.79%,NIV组则分别为10.25%、46.15%及76.92%,但两组差异无统计学意义(P=0.36)。结论 HFNC对中度AECOPD患者的呼吸支持治疗,与NIV具有类似的效果。
Objective To compare the efficacies of nasal high-flow oxygen therapy(HFNC) and noninvasive ventilation(NIV) on the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Eighty-two cases with moderate AECOPD were treated with HFNC, and 39 cases were treated with NIV. The clinical remission rate, PaCO_2 and oxygenation index of the two groups were compatred. Results As cmopared with those before the treatment,PaCO_2 and oxygenation index in 72 h after the treatment were significantly improved [(58.6±10.6)mmHg vs(46.1±9.4)mmHg,P=0.016;(149.3±20.8)mmHg vs(200.8±20.6)mmHg,P=0.024].There was no significant differences of PaCO_2 and oxygenation index in 24 h and 72 h after the treatment between HFNC group and NIV group(P>0.05). The clinical remission rates were 6.98%, 34.88% and 62.79% in the HFNC group on Day 3, 5 and 7, respectively; while those in the NIV group were 10.25%, 46.15% and 76.92%, respectively; but the differences between the two groups were not statistically significant(P=0.36). Conclusion The efficacy of HFNC in respiratory support therapy for patients with moderate AECOPD is similar to NIV.
Objective To compare the efficacies of nasal high-flow oxygen therapy(HFNC) and noninvasive ventilation(NIV) on the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Eighty-two cases with moderate AECOPD were treated with HFNC, and 39 cases were treated with NIV. The clinical remission rate, PaCO_2 and oxygenation index of the two groups were compatred. Results As cmopared with those before the treatment,PaCO_2 and oxygenation index in 72 h after the treatment were significantly improved [(58.6±10.6)mmHg vs(46.1±9.4)mmHg,P=0.016;(149.3±20.8)mmHg vs(200.8±20.6)mmHg,P=0.024].There was no significant differences of PaCO_2 and oxygenation index in 24 h and 72 h after the treatment between HFNC group and NIV group(P>0.05). The clinical remission rates were 6.98%, 34.88% and 62.79% in the HFNC group on Day 3, 5 and 7, respectively; while those in the NIV group were 10.25%, 46.15% and 76.92%, respectively; but the differences between the two groups were not statistically significant(P=0.36). Conclusion The efficacy of HFNC in respiratory support therapy for patients with moderate AECOPD is similar to NIV.
引文
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[6] Spoletini G,Alotaibi M,Blasi F,et al.Heated Humidified High Flow Nasal Oxygen in Adults:Mechanisms of Action and Clinical Implications[J].Chest,2015,148(1):253-261.
[7] Roca O,Pérez-Terán P,Masclans JR,et al.Patients with New York Heart Association class Ⅲ heart failure may beneft with high flow nasal cannula supportive therapy:high flow nasal cannula in heart failure[J].J Crit Care,2013,28(5):741-746.
[8] Barbier C,Loubières Y,Schmit C,et al.Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients[J].Intensive Care Med,2004,30(9):1740-1746.
[9] Parke R,McGuinness S,Dixon R,et al.Open-label,phase Ⅱ study of routine high-flow nasal oxygen therapy in cardiac surgical patients[J].Br J Anaesth,2013,111(6):925-931.
[10] Jones PG,Kimona S,Doran O,et al.Randomized controlled trial of humidifed high-flow nasal oxygen for acute respiratory distress in the emergency department:the HOT-ER study[J].Resp Care,2015,61(3):291-299.
[11] Lee MK,Choi J,Park B,et al.High flow nasal cannulae oxygen therapy in acute-moderate hypercapnic respiratory failure[J].Clin Respir J,2018,12(6):2046-2056.
[12] Corley A,Caruana LR,Barnett AG,et al.Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients[J].Br J Anaesth,2011,107(6):998-1004.
[13] Spence CJT,Buchmann NA,Jermy MC.Unsteady flow in the nasal cavity with high flow therapy measured by stereoscopic PIV[J].Exp Fluids,2012,52(3):569-579.
[14] Frizzola M,Miller TL,Rodriguez ME,et al.High-flow nasal cannula:impact on oxygenation and ventilation in an acute lung injury model[J].Pediatr Pulmonol,2011,46(1):67-74.
[2] Vos T,Flaxman AD,Naghavi M,et al.Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010:a systematic analysis for the Global Burden of Disease Study 2010[J].Lancet,2012,380(9859):2163-2196.
[3] Wedzicha JA,Seemungal TA.COPD exacerbations:defining their cause and prevention[J].Lancet,2007,370(9589):786-796.
[4] 慢性阻塞性肺疾病急性加重(AECOPD)专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2017年更新版)[J].国际呼吸杂志,2017,37(14):1041-1057.
[5] Ischaki E,Pantazopoulos I,Zakynthinos S.Nasal high flow therapy:a novel treatment rather than a more expensive oxygen device[J].Eur Respir Rev,2017,26(145):170028.
[6] Spoletini G,Alotaibi M,Blasi F,et al.Heated Humidified High Flow Nasal Oxygen in Adults:Mechanisms of Action and Clinical Implications[J].Chest,2015,148(1):253-261.
[7] Roca O,Pérez-Terán P,Masclans JR,et al.Patients with New York Heart Association class Ⅲ heart failure may beneft with high flow nasal cannula supportive therapy:high flow nasal cannula in heart failure[J].J Crit Care,2013,28(5):741-746.
[8] Barbier C,Loubières Y,Schmit C,et al.Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients[J].Intensive Care Med,2004,30(9):1740-1746.
[9] Parke R,McGuinness S,Dixon R,et al.Open-label,phase Ⅱ study of routine high-flow nasal oxygen therapy in cardiac surgical patients[J].Br J Anaesth,2013,111(6):925-931.
[10] Jones PG,Kimona S,Doran O,et al.Randomized controlled trial of humidifed high-flow nasal oxygen for acute respiratory distress in the emergency department:the HOT-ER study[J].Resp Care,2015,61(3):291-299.
[11] Lee MK,Choi J,Park B,et al.High flow nasal cannulae oxygen therapy in acute-moderate hypercapnic respiratory failure[J].Clin Respir J,2018,12(6):2046-2056.
[12] Corley A,Caruana LR,Barnett AG,et al.Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients[J].Br J Anaesth,2011,107(6):998-1004.
[13] Spence CJT,Buchmann NA,Jermy MC.Unsteady flow in the nasal cavity with high flow therapy measured by stereoscopic PIV[J].Exp Fluids,2012,52(3):569-579.
[14] Frizzola M,Miller TL,Rodriguez ME,et al.High-flow nasal cannula:impact on oxygenation and ventilation in an acute lung injury model[J].Pediatr Pulmonol,2011,46(1):67-74.