经鼻高流量湿化氧疗在COPD合并呼吸衰竭病人肺康复中的近期及远期疗效研究

目的探讨高流量湿化氧疗对COPD合并呼吸衰竭病人血气指标、肺部功能,近期、远期疗效的影响。方法以我院2017年1月至2020年5月老年病科收治的82例COPD合并呼吸衰竭病人作为观察对象,分为观察组42例和对照组40例。观察组病人给予高流量湿化氧疗,对照组给予无创正压通气治疗,比较2组病人干预后3 d的血气指标、肺功能、治疗效果、并发症发生情况及6个月后6分钟步行距离(6MWD)及改良英国医学研究委员会呼吸困难指数(mMRC)、COPD评估测试(CAT)评分、Borg评分与BODE指数结果。结果治疗3 d后,观察组病人PaO_(2)、FEV1、FEV1占预计值百分比、FVC占预计值百分比、FEV1/FVC均高于对照组(P<0.05),PaCO_(2)水平低于对照组(P<0.05);观察组的治疗有效率(92.85%)高于对照组(57.50%),2组并发症发生率差异无统计学意义(P>0.05)。随访6个月后,观察组6MWD、mMRC评分高于对照组(P<0.05),CAT评分、Borg评分及BODE指数低于对照组(P<0.05)。结论高流量湿化氧疗可改善COPD合并呼吸衰竭病人的血气指标和肺功能,改善疾病预后,值得临床应用。

Early-and long-term effect of high-flow nasal cannula oxygen therapy on pulmonary rehabilitation in COPD patients complicated with respiratory failure

Objective To explore the effects of high-flow nasal cannula oxygen therapy on blood gas indexes,pulmonary function in chronic obstructive pulmonary disease(COPD)patients complicated with respiratory failure,and to explore the complications and long-term effect.Methods A total of 82 subjects were selected in our hospital from January 2017 to May 2020 and divided into observation group(n=42)and control group(n=40).The patients in observation group received high-flow nasal cannula oxygen therapy,and the patients in control group were treated with non-invasive positive pressure ventilation therapy.The blood gas indexes,pulmonary function,effective rate and the complications after 3 days of treatment and the prognosis after 6 months of treatment were compared between the two groups.Results After 3 days of treatment,the levels of arterial partial pressure of oxygen(PaO₂),forced expiratory volume in 1 s(FEV1),FEV1%predicted(FEV1%pred),forced vital capacity(FVC)%predicted(FVC%pred),FEV1/FVC in observation group were higher than those in control group(P<0.05),while the level of partial pressure of carbon dioxide in artery(PaCO₂)was lower than that in control group(P<0.05).The effective rate of observation group(92.85%)was higher than that of control group(57.50%).There was no significant difference in the incidence rate of complications between the two groups(P>0.05).The 6-minute walk distance(6MWD)and the score of modified British medical research council(mMRC)were higher,while the score of COPD assessment test(CAT),Borg score and BODE index were lower than those in control group after 6 months of follow-up(P<0.05).Conclusions High-flow nasal cannula oxygen therapy can improve the blood gas indicators,pulmonary function and outcome,which has a significant clinical application value.