标题：HFNC治疗AECOPD合并呼吸衰竭的疗效及安全性研究

      作者：杨亚勤 1，孙冰 2，马彦娟 1，吴畏 1，杨飞云 1    新乡医学院第一附属医院急救医学科 1、结核内一科 2，河南 卫辉 453100

      卷次： 2024年35卷14期

      【摘要】 目的 探讨经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭的疗效及安全性。方法 选择2021年1月至2023年1月新乡医学院第一附属医院收治的80例AECOPD合并呼吸衰竭患者进行研究，按随机数表法分为观察组和对照组各40例。对照组患者给予无创正压通气(NIPPV)治疗，观察组患者给予HFNC治疗，两组患者均连续治疗1周。比较两组患者的临床疗效及治疗前后的肺功能指标[第一秒最大呼气容积(FEV1)、FEV1与用力肺活量比值(FEV1/FVC)%、最大呼气流量(PEF)]、动脉血气指标[动脉氧分压(PaO2)、动脉二氧化碳(PaCO2)、血氧饱和度(SpO2)]、炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)、白细胞介素-4 (IL-4)、白细胞介素-6 (IL-6)]水平，并记录两组患者的并发症发生情况。结果 观察组患者的治疗总有效率为95.00%，明显高于对照组的 80.00%，差异有统计学意义(P<0.05)；观察组患者治疗后的FEV1、FEV1/FVC、PEF水平分别为(1.85±0.36) L、(68.64±6.73)%、(3.80±1.04) L/s，明显高于对照组的(1.53±0.38) L、(62.48±6.24)%、(3.26±0.98) L/s，差异均具有统计学意义(P<0.05)；观察组患者治疗后的PaO2、SpO2水平分别为(88.46±6.73) mmHg、(86.25±12.31)%，明显高于对照组的(82.33±7.94) mmHg、(78.37±13.62)%，PaCO2水平为(34.30±8.51) mmHg，明显低于对照组的(40.62±6.44) mmHg，差异均具有统计学意义(P<0.05)；观察组患者治疗后的CRP、TNF-α、IL-4、IL-6水平分别为(5.16±0.32) mg/L、(30.93±2.60) mg/L、(40.81±6.54) pg/L、(41.02±7.60) pg/L，明显低于对照组的(7.57±1.02) mg/L、(52.78±3.83) mg/L、(57.04±7.40) pg/L、(64.86±8.91) pg/L，差异均有统计学意义(P<0.05)；治疗后，观察组患者的鼻舌干燥、腹胀、面部压伤的发生率分别为5.00%，2.50%，0，明显低于对照组的22.50%，17.50%，12.50%，差异均有统计学意义(P<0.05)，而两组患者的低血压发生率比较差异无统计学意义(P>0.05)。结论 HFNC治疗AECOPD合并呼吸衰竭能提高患者的肺功能，改善动脉血气指标，降低炎症指标和并发症的发生率，临床应用效果显著。
      【关键词】 慢性阻塞性肺疾病急性加重期；呼吸衰竭；经鼻高流量湿化氧疗；肺功能；炎症因子
      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2024）14—1986—05

Efficacy and safety of high-flow nasal cannula therapy in the treatment of acute exacerbation of chronicobstructive pulmonary disease complicated with respiratory failure.
YANG Ya-qin 1, SUN Bing 2, MA Yan-juan 1, WUWei 1, YANG Fei-yun 1. Department of Emergency Medicine 1, the First Department of Tuberculosis 2, the First AffiliatedHospital of Xinxiang Medical University, Weihui 453100, Henan, CHINA
【Abstract】 Objective To investigate the efficacy and safety of high-flow nasal cannula (HFNC) therapy in thetreatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory fail-ure. Methods A total of 80 patients with AECOPD combined with respiratory failure admitted to the First AffiliatedHospital of Xinxiang Medical College from January 2021 to January 2023 were selected for the study, and they were di-vided into an observation group and a control group by random number table method, with 40 cases in each group. Pa-tients in the control group were treated with non-invasive positive pressure ventilation (NIPPV), and patients in observa-tion group were treated with HFNC, all for 1 week. The clinical efficacy was compared between the two groups, as wellas the pulmonary function indexes [forced expiratory volume in one second (FEV1), ratio of FEV1 to forced vital capacity(FEV1/FVC)%, peak expiratory flow (PEF)], arterial blood gas indexes [arterial partial pressure of oxygen (PaO2), arteri-al partial pressure of carbon dioxide (PaCO2), blood oxygen saturation (SpO2)], and inflammatory factors [C-reactive pro-tein (CRP), tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6)]. The occurrence of complica-tions were recorded after treatment. Results After treatment, the total effective rate in the observation group was95.00%, which was significantly higher than 80.00% in the control group (P<0.05). The levels of FEV1, FEV1/FVC, andPEF in the observation group after treatment were (1.85±0.36) L, (68.64±6.73)%, and (3.80±1.04) L/s, respectively,which were significantly higher than (1.53±0.38) L, (62.48±6.24)%, (3.26±0.98) L/s in the control group (P<0.05). ThePaO2 and SpO2 levels in the observation group after treatment were (88.46±6.73) mmHg and (86.25±12.31)%, whichwere significantly higher than (82.33 ± 7.94) mmHg and (78.37 ± 13.62)% in the control group; the PaCO2 level was(34.30±8.51) mmHg, which was significantly lower than (40.62±6.44) mmHg in the control group; the differences werestatistically significant (P<0.05). The CRP, TNF-α, IL-4, and IL-6 levels in the observation group after treatment were(5.16±0.32) mg/L, (30.93±2.60) mg/L, (40.81±6.54) pg/L, and (41.02±7.60) pg/L, which were significantly lower than(7.57±1.02) mg/L, (52.78±3.83) mg/L, (57.04±7.40) pg/L, and (64.86±8.91) pg/L in the control group (P<0.05). Aftertreatment, the incidences of nasal and tongue dryness, abdominal distension, and facial compression injuries in the obser-vation group were 5.00%, 2.50%, and 0, which were significantly lower than 22.50%, 17.50%, and 12.50% in the controlgroup (P<0.05). Conclusion HFNC in the treatment of AECOPD combined with respiratory failure can improve thelung function of patients, improve arterial blood gas indexes, reduce inflammatory factors and the incidence of complica-tions, which is worthy of clinical application.
      【Key words】 Acute exacerbation of obstructive pulmonary disease; Respiratory failure; High-flow nasal cannulatherapy; Lung function; Inflammatory factors