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经鼻高流量氧疗对稳定期慢性阻塞性肺疾病合并高碳酸血症的疗效分析

Effect of high-flow nasal cannula oxygen therapy on stable chronic obstructive pulmonary disease complicating with hypercapnia

    摘要
  • 摘要:
    目的 分析经鼻高流量氧疗(HFNC)对稳定期慢性阻塞性肺疾病(COPD)合并高碳酸血症患者的干预效果。
    方法 选取45例需长期氧疗的稳定期COPD合并高碳酸血症患者作为研究对象，根据不同呼吸支持模式分为长期家庭氧疗(LTOT)组、无创通气(NIV)组、HFNC组，每组15例。比较3组患者出院后一般情况、血气指标、肺功能指标、呼吸状况、生活质量及步行试验结果。
    结果 随访期内, HFNC组、NIV组住院次数、急性加重次数均少于LTOT组，差异有统计学意义(P < 0.05); 出院后6、12个月, 3组动脉血二氧化碳分压pa(CO2)低于出院前，动脉血氧分压pa(O2)、脉搏血氧饱和度(SpO2)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)高于出院前，且HFNC组上述指标变化程度大于NIV组、LTOT组，差异有统计学意义(P < 0.05); 出院后1、3、6、12个月, 3组英国医学研究委员会呼吸困难量表(mMRC)评分、圣乔治呼吸问卷(SGRQ)评分均逐渐降低, 6 min步行距离(6MWD)均逐渐增加，且HFNC组上述指标变化程度大于NIV组、LTOT组，差异有统计学意义(P < 0.05)。
    结论 HFNC可有效减轻稳定期COPD合并高碳酸血症患者呼吸困难症状，改善肺功能，促进血气指标恢复正常，还可提升生活质量和运动耐力，降低再入院率。

     

    Abstract:
    Objective To analyze the interventional effect of high-flow nasal cannula oxygen (HFNC) therapy in patients with stable chronic obstructive pulmonary disease (COPD) combined with hypercapnia.
    Methods A total of 45 patients with stable COPD complicating with hypercapnia who require long-term oxygen therapy were selected as study subjects. They were divided into three groups based on different respiratory support modes: long-term home oxygen therapy (LTOT) group, non-invasive ventilation (NIV) group, and HFNC group, with 15 patients in each group. The general condition, blood gas index, lung function index, respiratory status, quality of life, and walking test results of the three groups were compared after discharge.
    Results During the follow-up period, the number of admission and acute exacerbation in the HFNC group and NIV group was lower than that in the LTOT group (P < 0.05). At 6 and 12 months after discharge, the arterial partial pressure of carbon dioxide pa(CO2) in the three groups was lower than before discharge, while the arterial partial pressure of oxygenpa(O2), pulse oxygen saturation (SpO2), forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) were higher than before discharge. Moreover, the changes in the above indicators in the HFNC group were greater than those in the NIV group and LTOT group (P < 0.05). At 1-, 3-, 6-, and 12-month after discharge, the scores of dyspnea scale of the modified Medical Research Council (mMRC) and the St. George′s Respiratory Questionnaire (SGRQ) in the three groups gradually decreased, and the 6-minute walking distance (6MWD) gradually increased. Additionally, the changesin the above indicators in the HFNC group were greater than those in the NIV group and LTOT group (P < 0.05).
    Conclusion HFNC can effectively alleviate dyspnea symptoms, improve lung function, promote the recovery of blood gas indicators, enhance quality of life and exercise tolerance, and reduce re-hospitalization rates in patients with stable COPD combined with hypercapnia.

     

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