经鼻高流量氧疗治疗慢性阻塞性肺疾病合并高碳酸血症疗效及对患者血浆EOS水平和血气分析指标的影响

doi:10.3969/j.issn.1006-6233.2021.04.017

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摘要 目的: 探讨经鼻高流量氧疗(high-flow nasal cannula,HFNC)治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并高碳酸血症疗效及对患者血浆嗜酸性粒细胞(eosinophils,EOS)和血气分析指标的影响。方法: 回顾性分析2015年1月至2020年6月于我院接受肺康复治疗的162例稳定期重度COPD合并高碳酸血症患者的临床资料,按照出院后的治疗方法分为HFNC组(n=88)与传统组(n=74)。两组患者均给予常规治疗,传统组加以传统鼻导管氧疗治疗,HFNC组加以HFNC治疗。比较两组治疗前、治疗6个月后的肺功能[1s用力呼气容积(Forced expiratory volume in one second,FEV1)、用力肺活量(Forced Vital Capacity,FVC)、FEV1/FVC]、血气分析指标[PH值、动脉血氧分压(partial pressure of oxygen in artery,PaO₂)、二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO₂)、脉搏血氧饱和度(pulse oxygen saturation,SpO₂)]、血浆EOS及运动耐力[日常生活活动能力量表(Activities of daily living,ADL)、6min步行试验(6min walking test,6MWT)]变化。结果: 治疗前,两组FEV1、FVC、FEV1/FVC、PH值、PaO₂、PaCO₂、SpO₂、EOS、ADL量表评分及6MWT比较无统计学意义(P均>0.05),治疗6个月后,HFNC组FEV1、FVC、FEV1/FVC、PH值、PaO₂、SpO₂、6MWT水平明显高于传统组(P<0.05),PaCO₂、EOS水平、ADL量表(躯体自理能力、工具性日常生活能力)各分量表评分明显低于传统组(P<0.05),且治疗前后差值明显高于对照组(P<0.05)。结论: HFNC在稳定期重度COPD合并高碳酸血症患者出院后肺康复治疗效果较传统低流量氧疗更优,值得推广。

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	周小曼
	林梅
	张裕田

关键词 ：经鼻高流量氧疗, 慢性阻塞性肺疾病, 高碳酸血症, 嗜酸性粒细胞, 血气分析

Abstract：Objective: To investigate the efficacy of high-flow nasal cannula (HFNC) in the treatment of chronic obstructive pulmonary disease (COPD) with hypercapnia and its effects on levels of plasma eosinophils (EOS) and blood gas analysis indicators.Methods: The clinical data of 162 patients with severe COPD complicated with hypercapnia during stable stage who received pulmonary rehabilitation therapy in our hospital from January 2015 to June 2020 were retrospectively analyzed. The patients were divided into HFNC group (n=88) and traditional group (n=74) according to the treatment methods after discharge. Both groups were given conventional treatment, and traditional group was additionally treated with traditional nasal catheter oxygen therapy, and HFNC group was additionally treated with HFNC. The lung function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC], blood gas analysis indexes [PH value, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), pulse oxygen saturation (SpO₂)], plasma EOS and exercise endurance [Activities of daily living (ADL), 6min walking test (6MWT)] were compared between the two groups before treatment and after 6 months of treatment. Results: Before treatment, there were no statistical differences in FEV1, FVC, FEV1/FVC, pH value, PaO₂, PaCO₂, SpO₂, EOS, scores of ADL scale and 6MWT between the two groups (all P>0.05). After 6 months of treatment, the FEV1, FVC, FEV1/FVC, PH value, PaO₂, SpO₂ and 6MWT in HFNC group were significantly higher than those in traditional group (P<0.05) while the PaCO₂, EOS and scores of subscales of ADL scale (physical self-care ability, instrumental activities of daily living) were significantly lower than those in traditional group (P<0.05), and the differences before and after treatment were significantly higher than those in control group (P<0.05). Conclusion: HFNC is more effective than traditional low-flow oxygen therapy in pulmonary rehabilitation after discharge in patients with severe COPD complicated with hypercapnia during stable stage, thus it is worthy of promotion.

Key words： High-flow nasal cannula Chronic obstructive pulmonary disease Hypercapnia Eosinophils Blood gas analysis

基金资助:海南省卫生健康行业科研项目,(编号:20A200268)

引用本文:

周小曼, 林梅, 张裕田. 经鼻高流量氧疗治疗慢性阻塞性肺疾病合并高碳酸血症疗效及对患者血浆EOS水平和血气分析指标的影响[J]. 河北医学, 2021, 27(4): 604-609.
ZHOU Xiaoman, LIN Mei, ZHANG Yutian. Efficacy of High-flow Nasal Cannula on Chronic Obstructive Pulmonary Disease with Hypercapnia and Its Effects on Levels of Plasma EOS Level and Blood Gas Analysis Indicators. HeBei Med, 2021, 27(4): 604-609.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.04.017 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I4/604

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