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  • 喻正浩,张瑞,黄卉,李俊,耿爽.经鼻高流量湿化氧疗应用于慢性阻塞性肺疾病合并2型呼吸衰竭患者气管插管拔管后的疗效和安全性:随机对照研究[J].第二军医大学学报,2019,40(9):989-994    [点击复制]
  • YU Zheng-hao,ZHANG Rui,HUANG Hui,LI Jun,GENG Shuang.Efficacy and safety of humidified high flow nasal cannula in chronic obstructive pulmonary disease complicated with type 2 respiratory failure patients after extubation: a randomized controlled trial[J].Acad J Sec Mil Med Univ,2019,40(9):989-994   [点击复制]
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经鼻高流量湿化氧疗应用于慢性阻塞性肺疾病合并2型呼吸衰竭患者气管插管拔管后的疗效和安全性:随机对照研究
喻正浩1,张瑞2,黄卉1,李俊1,耿爽1*
0
(1. 华中科技大学同济医学院附属武汉中心医院呼吸内科, 武汉 430000;
2. 宁夏医科大学总医院呼吸与危重症医学科, 银川 750004
*通信作者)
摘要:
目的 比较经鼻高流量湿化氧疗(HHFNC)和无创正压通气(NPPV)在慢性阻塞性肺疾病(COPD)合并2型呼吸衰竭患者气管插管拔管后的干预效果和安全性。方法 纳入72例行机械通气治疗并拔除气管插管的COPD合并严重2型呼吸衰竭患者,按1∶1比例将患者随机分为HHFNC组和NPPV组,每组36例。对比两组患者在治疗前、治疗开始后不同时间点(2、12、24 h)及治疗结束时的血气分析指标、呼吸频率、心率、平均动脉压、再次插管率、气管切开率、重症监护病房停留时间、不良事件发生率和死亡率的差异。结果 HHFNC组治疗24 h时的血液pH值、治疗2 h与12 h时的动脉血氧分压(PaO2)及治疗2 h与12 h时的氧合指数(PaO2/FiO2)均高于NPPV组,而治疗12 h时的动脉血二氧化碳分压(PaCO2)、治疗各时间点(2、12、24 h)的呼吸频率及治疗12 h与24 h时的心率均低于NPPV组,差异均有统计学意义(P均<0.05)。两组患者再次插管率、气管切开率及重症监护病房停留时间的差异均无统计学意义(P均>0.05),HHFNC组不良事件总发生率、不耐受发生率、胃肠胀气发生率和误吸发生率均低于NPPV组,差异均有统计学意义(P均<0.05)。两组患者死亡率差异无统计学意义(P>0.05)。结论 HHFNC对COPD合并2型呼吸衰竭患者气管插管拔管后的短期治疗效果和安全性优于NPPV。
关键词:  慢性阻塞性肺疾病  2型呼吸衰竭  经鼻高流量湿化氧疗  无创正压通气  治疗结果  安全性
DOI:10.16781/j.0258-879x.2019.09.0989
投稿时间:2019-03-22修订日期:2019-05-22
基金项目:
Efficacy and safety of humidified high flow nasal cannula in chronic obstructive pulmonary disease complicated with type 2 respiratory failure patients after extubation: a randomized controlled trial
YU Zheng-hao1,ZHANG Rui2,HUANG Hui1,LI Jun1,GENG Shuang1*
(1. Department of Respiratory, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China;
2. Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
*Corresponding author)
Abstract:
Objective To compare the efficacy and safety between humidified high flow nasal cannula (HHFNC) and noninvasive positive pressure ventilation (NPPV) in patients with chronic obstructive pulmonary disease (COPD) complicated with type 2 respiratory failure after extubation. Methods Seventy-two patients with COPD complicated with type 2 respiratory failure were enrolled after extubation and were randomized into HHFNC group and NPPV group at 1:1 ratio, with 36 patients in each group. The blood gas analysis index, respiratory rate, heart rate, mean arterial pressure, reintubation rate, incidence of tracheotomy, intensive care unit stay, incidence of adverse events and mortality were compared between the two groups before treatment and 2, 12, 24 h after treatment. Results The pH at 24 h, partial pressure of oxygen in artery (PaO2) at 2 h and 12 h, and oxygenation index (PaO2/FiO2) at 2 h and 12 h after treatment were significantly higher in the HHFNC group compared with the NPPV group (all P<0.05), while partial pressure of carbon dioxide in artery (PaCO2) at 12 h, respiratory rate at 2 h, 12 h and 24 h, and heart rate at 12 h and 24 h after treatment were significantly lower in the HHFNC group compared with the NPPV group (all P<0.05). There were no significant differences in reintubation rate, incidence of tracheotomy or intensive care unit stay between the two groups (all P>0.05), while the overall incidence of adverse events, intolerance rate, flatulence rate and aspiration rate were significantly lower in the HHFNC group than those in the NPPV group (all P<0.05). The mortality rates were not significantly different between the two groups (P>0.05). Conclusion The short-time efficacy and safety of HHFNC are better than NPPV in treatment of COPD complicated with type 2 respiratory failure.
Key words:  chronic obstructive pulmonary disease  type 2 respiratory failure  humidified high flow nasal cannula therapy  noninvasive positive pressure ventilation  outcomes  safety