老年COPD合并Ⅱ型呼吸衰竭患者气管切开术后采用序贯经鼻高流量加温湿化氧疗对患者呼吸道感染及临床结局的影响

doi:10.3969/j.issn.1671-7171.2023.05.019

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摘要【目的】探讨老年慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)合并Ⅱ型呼吸衰竭患者气管切开术后采用序贯经鼻高流量加温湿化氧疗对患者呼吸道感染及临床结局的影响。【方法】选取2018年5月至2020年5月本院收治的96例老年COPD合并Ⅱ型呼吸衰竭气管切开术后患者,按照随机数字表法分为观察组和对照组,每组48例。对照组采用无创正压通气治疗,观察组采用序贯经鼻高流量加温湿化氧疗,比较两组患者平均吸痰次数、痰液黏稠度、呼吸道感染情况、自主呼吸时间、ICU滞留时间、28 d内病死率、临床疗效、呼吸动力学指标、血气分析指标、肺功能指标以及不良反应发生情况。【结果】观察组平均吸痰次数、自主呼吸时间、ICU滞留时间、呼吸道感染发生率均少于对照组(P<0.05);两组28 d内病死率比较,差异无统计学意义(P>0.05);观察组总有效率高于对照组(P<0.05)。治疗后,观察组平均气道压、气道阻力、血二氧化碳分压(PaCO₂)均低于对照组(P<0.05),血氧分压(PaO₂)、第一秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】老年COPD合并Ⅱ型呼吸衰竭患者气管切开术后采用序贯经鼻高流量加温湿化氧疗,可降低患者呼吸道感染率,改善临床结局,同时可提高肺功能,且安全可靠,值得临床推广应用。

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	司艳
	张娜娜

关键词 ：肺疾病,慢性阻塞性/并发症, 呼吸功能不全/并发症, 气管切开术, 氧吸入疗法, 呼吸道感染, 老年人

Abstract：【Objective】To explore the effect of post-tracheotomy sequential transnasal high-flow humidification and oxygen therapy on respiratory tract infection and clinical outcomes in elderly patients with chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure. 【Methods】A total of 96 elderly patients with COPD and type Ⅱ respiratory failure,who were admitted to the hospital for tracheotomy from May 2018 to May 2020,were selected and divided into the observation group and the control group. According to the random number table method,there were 48 cases in each group. The control group was treated with non-invasive positive pressure ventilation,while the observation group was treated with sequential nasal high-flow humidification and oxygen therapy. The average sputum suction times,sputum viscosity,respiratory tract infection,spontaneous breathing time,ICU stay time,clinical efficacy,respiratory dynamics,blood gas analysis,pulmonary function and adverse reactions were compared between the two groups. 【Results】The average number of sputum suctions,spontaneous breathing time,ICU stay time,and incidence of respiratory tract infection in the observation group were lower than those in the control group (P<0.05). There was no significant difference in the 28-day mortality between the observation group and the control group (P>0.05). The total effective rate of the observation group was higher than that of the control group (P<0.05). After treatment,the average airway pressure and airway resistance of the observation group were lower than those of the control group (P<0.05). After treatment,the blood partial pressure of oxygen (PaO₂) in the observation group was higher than that in the control group (P<0.05),and the blood carbon dioxide partial pressure (PaCO₂) in the observation group was lower than that in the control group (P<0.05). After treatment,the forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity (FVC) of the observation group were higher than those of the control group. There was no significant difference in the incidence of adverse reactions between the observation group and the control group (P>0.05). 【Conclusion】 Sequential nasal high-flow humidification and oxygenation therapy after tracheotomy in elderly patients with chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure can reduce the rate of respiratory tract infection,improve clinical outcomes,and improve lung function at the same time,which is safe and reliable.

Key words： Pulmonary Disease,Chronic Obstructive/CO Respiratory Insufficiency/CO Tracheotomy Oxygen Inhalation Therapy Respiratory Tract Infections Aged

收稿日期: 2022-11-28

中图分类号:

R563

通讯作者: *E-mail:2680182836@qq.com

引用本文:

司艳, 张娜娜. 老年COPD合并Ⅱ型呼吸衰竭患者气管切开术后采用序贯经鼻高流量加温湿化氧疗对患者呼吸道感染及临床结局的影响[J]. 医学临床研究, 2023, 40(5): 706-709.
SI Yan, ZHANG Na-na. Effects of Post-Tracheotomy Sequential Transnasal High-flow Humidification and Oxygenation Therapy on Respiratory Tract Infection and Clinical Outcomes in Elderly Patients with Chronic Obstructive Pulmonary Disease Complicated with Type Ⅱ Respiratory Failure. JOURNAL OF CLINICAL RESEARCH, 2023, 40(5): 706-709.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.05.019 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I5/706

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