吴少珠 周宇麒 张苍 於雪英 刘燕飞 区洁兰

【摘要】目的 比較经鼻高流量湿化氧疗（HFNC）与无创正压通气（NPPV）在COPD急性加重（AECOPD）合并呼吸衰竭患者的临床效果及安全性。方法 选取AECOPD合并慢性呼吸衰竭患者，分为HFNC组和NPPV组，每组各34例。2组在相同的综合治疗方案基础上，HFNC组给予经鼻高流量湿化氧疗，NPPV组给予无创正压通气治疗，在治疗前、后对患者行血气分析及痰液黏稠度分度，分析PaO2、PaCO2及痰液黏稠度变化，治疗期间观察患者腹胀、颜面部压迫等不良反应发生情况，治疗结束后由患者对辅助通气模式进行主观舒适度评分，比较2组上述指标的差异。结果 治疗前，2组AECOPD合并呼吸衰竭患者的PaO2、PaCO2、痰液黏稠度比较差异均无统计学意义（P均> 0.05）。治疗后，2组患者的PaO2、PaCO2、痰液黏稠度均比治疗前改善（P均< 0.05），其中HFNC组的PaCO2、痰液黏稠度均低于NPPV组（P均< 0.05）。治疗期间HFNC组无患者出现腹胀，NPPV组7例（21%）患者出现腹胀;HFNC组患者发生颜面部压迫1例（3%），NPPV组为9例（26%）。HFNC组患者的腹胀、颜面部压迫发生率均低于NPPV组（P均< 0.05）。治疗后，HFNC组患者的舒适度总分、生理维度、心理精神维度、环境维度得分均高于NPPV组（P均< 0.05）。结论 HFNC可改善AECOPD合并呼吸衰竭患者的缺氧状态，并有利于患者痰液稀化，且安全性高。

【关键词】经鼻高流量湿化治疗;无创正压通气治疗;慢性阻塞性肺疾病急性加重;呼吸衰竭

【Abstract】Objective To compare the clinical efficacy and safety of high-flow nasal cannula （HFNC） and non-invasive positive pressure ventilation （NPPV） with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with chronic respiratory failure.  Methods A total of 68 AECOPD  patients were recruited and randomly assigned into the HFNC （n = 34） and NPPV groups （n = 34）. On the basis of comprehensive treatment， nasal high-flow humidified oxygen therapy was delivered in the HFNC group， and non-invasive positive pressure ventilation was given in the NPPV group. Blodd gas analysis and sputum viscosity were assessed before and after corresponding interventions. The changes of PaO2， PaCO2 and sputum viscosity were analyzed. The incidence of adverse reactions， such as abdominal distention and facial compression， were observed during the treatment. After interventions， the subjective comfort level of the auxiliary ventilation was scored by the patients. All these parameters were statistically compared between the HENC and NPPV groups.  Results Before treatment， the PaO2， PaCO2 and sputum viscosity did not significantly differ between the HFNC and NPPV groups （all P > 0.05）. After interventions， the three parameters were significantly improved in both groups （all P < 0.05）. The PaCO2 and sputum viscosity in the HFNC group were considerably lower compared with those in the NPPV group （both P < 0.05）. During treatment， abdominal distension occurred in 7 cases （21%） in the NPPV group， whereas none （0%） in the HFNC group （P < 0.05）. Facial compression was observed in 1 patient （3%） in the HFNC group， significantly lower than 9 cases （26%） in the NPPV group （P < 0.05）. In addition， the total score in comfort level and the sub-scores in physiological， psychological and environmental dimensions in the HFNC group were significantly higher than those in the NPPV group （all P < 0.05）.  Conclusion Compared with NPPV， HFNC can significantly dilute the sputum viscosity， improve the hypoxia， and reduce the risk of adverse reactions in the treatment of AECOPD patients complicated with respiratory failure.

【Key words】High-flow nasal cannula;Non-invasive positive pressure ventilation;

Acute exacerbation of chronic obstructive pulmonary disease;Respiratory failure

COPD是以持续存在的呼吸道症状和气流受限为特征的呼吸道疾病[1]。COPD急性加重（AECOPD）以呼吸困难、痰液增多、脓性痰等临床表现为特征[2-3]。AECOPD合并呼吸衰竭可导致患者住院、致残甚至死亡，严重威胁着人们的健康。经鼻高流量湿化氧疗（HFNC）是近年应用于AECOPD的辅助呼吸治疗新方法。既往研究显示，患者经过HFNC治疗后PaO2升高、PaCO2下降，病情得到明显改善[4]。患者接受辅助通气治疗的依从性也有所增加。本研究进一步评价HFNC和无创正压通气（NPPV）的临床效果与安全性，现报告如下。

对象与方法

一、研究对象

选取2016年7月至2017年11月在我科住院的68例AECOPD合并呼吸衰竭患者作为研究對象。病例……