肖祖华　周峰　文雨　邓行江　黄子祺

【摘要】 目的：探討交替使用高流量湿化氧疗（HFNC）、无创正压通气（NPPV）在慢性阻塞性肺疾病（COPD）合并肺源性心脏病患者中的应用效果。方法：选取2020年1-7月本院呼吸内科及重症医学科收治的90例COPD合并肺源性心脏病患者。按随机对照原则分为无创正压通气组（NPPV）30例、高流量湿化氧疗组（HFNC）30例和联合组30例。三组均行常规治疗，NPPV组给予NPPV治疗，HFNC组给予HFNC，联合组交替使用NPPV、HFNC治疗。治疗3 d后，比较三组肺功能、血气指标、血清指标及临床疗效。结果：治疗3 d后，联合组治疗总有效率为96.97%，高于HFNC组和NPPV组的73.33%，差异有统计学意义（P<0.05）。治疗后，三组FVC、FEV1、FEV1/FVC%水平均较治疗前上升，联合组水平高于HFNC组和NPPV组，差异均有统计学意义（P<0.05）。治疗后，三组PaO2水平均较治疗前上升，PaCO2水平较治疗前降低，且联合组上述指标水平变化较HFNC组、NPPV组显著，差异均有统计学意义（P<0.05）。治疗后，三组CRP、NT-proBNP水平均较治疗前降低，且联合组水平较HFNC组、NPPV组低，差异均有统计学意义（P<0.05）。结论：交替使用HFNC、NPPV治疗COPD并肺源性心脏病患者疗效显著，可改善肺功能及血气指标。

【关键词】 慢性阻塞性肺疾病 肺源性心脏病 高流量湿化氧疗 无创正压通气 肺功能 血气指标

[Abstract] Objective： To investigate the application effect of alternate use of high flow humidified oxygen therapy （HFNC） and noninvasive positive pressure ventilation （NPPV） in patients with chronic obstructive pulmonary disease （COPD） and pulmonary heart disease. Method： A total of 90 patients with COPD and pulmonary heart disease admitted to the department of respiratory medicine and critical care medicine of our hospital from January to July 2020 were selected. According to the randomized control principle， they were divided into the non-invasive positive pressure ventilation group （NPPV）， the high-flow humidified oxygen therapy group （HFNC） and the combined group， 30 cases in each group. All three groups received routine treatment， NPPV group received NPPV treatment， HFNC group received HFNC， and the combined group alternately received NPPV and HFNC treatment. After 3 days of treatment， pulmonary function， blood gas index， serum index and clinical efficacy were compared among the three groups. Result： After 3 days of treatment， the total effective rate of the combination group was 96.97%， higher than 73.33% of HFNC group and NPPV group， with statistically significant difference （P<0.05）. After treatment， the levels of FVC， FEV1， and FEV1/FVC% in three groups were all increased compared with those of before treatment， and the levels of the combined group was higher than those of HFNC group and NPPV group， with statistically significant differences （P<0.05）. After treatment， the levels of PaO2 in three groups all increased compared with those of before treatment， while the levels of PaCO2 in three groups decreased compared with thoe of before treatment， moreover， the changes in the levels of the above indicators in the combination group were significantly higher than those in HFNC group and NPPV group， with statistically significant differences （P<0.05）. After treatment， the levels of CRP and NT-proBNP in three groups were all lower than those of before treatment， and the levels of the combined group were lower than those of HFNC group and NPPV group， with statistically significant differences （P<0.05）. Conclusion： Alternating use of HFNC and NPPV in the treatment of COPD with pulmonary heart disease has a significant effect， can improve lung function and blood gas indicators.

[Key words] Chronic obstructive pulmonary disease Pulmonary heart disease High flow humidification oxygen therapy Noninvasive positive pressure ventilation Lung function Blood gas index

First-authors address： Shaoguan Railway Hospital， Shaoguan 512023， China

doi：10.3969/j.issn.1674-4985.2021.03.004

慢性阻塞性肺疾病（COPD）是常见的慢性呼吸系统疾病，近年来发病率呈上升趋势，且具有难治愈、致死率高等特点，早期症状轻微，病情长期持续易引发各种并发症。因肺部病变导致肺血管床减少等现象，以及肺动脉痉挛、血管重塑等原因，导致肺动脉高压，最终转变为慢性肺源性心脏病，故及时治疗十分重要。NPPV为目前常用呼吸辅助方式，在治疗慢性肺病及肺康复等方面效果理想，但不适用于感染严重或气道分泌物过多患者[1]。高流量湿化氧疗（HFNC）是一种新型呼吸辅助方式，其舒适度高、耐受性强，可弥补NPPV不足之处，但可提供的通气作用有限，对于呼吸衰竭等严重患者疗效局限[2]。而临床关于两者交替使用相关研究较少，故本研究探讨了交替使用HFNC、NPPV治疗COPD并肺源性心脏病患者的效果，现报道如下。……