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摘要：
目的 比较慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease, AECOPD）患者以肺部感染控制窗（pulmonary infection control window, PIC‑W）为切换点序贯经鼻高流量湿化氧疗（high‑flow nasal cannula oxygen therapy, HFNC）与序贯无创正压通气（non‑invasive positive pressure ventilation, NPPV）的临床疗效。 方法 选取徐州医科大学附属医院急诊重症医学科2019年11月至2020年10月收治的AECOPD有创机械通气患者70例，满足PIC‑W后按随机数字表法分为HFNC组和NPPV组（每组35例），分别在常规治疗基础上予HFNC和NPPV序贯通气治疗。收集患者一般资料、急性生理与慢性健康评分Ⅱ（Acute Physiological and Chronic Health Evaluation Ⅱ, APACHEⅡ）评分；比较两组患者拔管前1 h和治疗后2、24、72 h动脉血气指标，包括PaCO2、PaO2、pH值、乳酸（lactic acid, Lac）及氧合指数；记录舒适度评分；比较两组患者并发症发生率及再插管率。 结果 两组患者一般情况与APACHEⅡ评分差异均无统计学意义（P>0.05）。两组患者治疗后72 h PaO2、氧合指数均高于拔管前1 h（P<0.001），治疗后72 h PaCO2均低于拔管前1 h（P<0.001）。HFNC组治疗后2、24、72 h舒适度评分均高于NPPV组（P<0.05）。HFNC组鼻唇干燥、腹胀、鼻面部压疮发生率均低于NPPV组（P<0.05）；两组患者再插管率比较差异无统计学意义（P>0.05）。其余指标差异无统计学意义（P>0.05）。 结论 对于接受有创通气治疗的AECOPD患者，以PIC‑W为序贯通气切换点分别使用HFNC与NPPV，HFNC和NPPV均能改善呼吸功能、提高氧合指数，但HFNC能显著提高患者舒适度；对于不能耐受NPPV治疗的拔管后AECOPD患者，HFNC可作为序贯替代治疗方式。
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Abstract: Objective To compare the clinical effectiveness of sequential high‑flow nasal cannula (HFNC) oxygen therapy and sequential non‑invasive positive pressure ventilation (NPPV) switched by pulmonary infection control window (PIC‑W) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 70 AECOPD patients with invasive mechanical ventilation who were admitted to Department of Emergency and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University from November 2019 to October 2020 were enrolled. After meeting PIC‑W, they were divided into two groups (n=35): a HFNC group and a NPPV group, according to the random number table method. HFNC and NPPV sequential treatment were performed in addition to routine treatment. Then, their general information and Acute Physiological and Chronic Health Evaluation Ⅱ (APACHEⅡ) were collected. The arterial blood gas, including PaCO2, PaO2, pH value, lactic acid (Lac) and oxygenation index were observed 1 h before extubation, and 2, 24 h and 72 h after treatment. The comfort score was recorded. Both groups were compared for their incidence of complication and the re‑intubation rate. Results There was no statistical difference in general information and APACHEⅡ scores between the two groups (P>0.05). Compared with those 1 h before exbubation, patients in both groups showed increases in PaO2 and oxygenation index, as well as decreases in PaCO2 72 h after treatment (P<0.001). Then, 2, 24 h, and 72 h after treatment, the HFNC group presented higher comfort scores than the NPPV group (P<0.05). The incidences of nasal and labial dryness, nasal and facial pressure ulcer, and abdominal distention in the HFNC group were lower than those in the NPPV group (P<0.05). There was no statistical difference in the re‑intubation rate between the two groups (P>0.05). There was no significant difference in other indicators (P>0.05). Conclusions For AECOPD patients receiving invasive ventilation therapy, with HFNC and NPPV sequential treatment switched by PIC‑W, the HFNC and NPPV groups can improve the respiratory function and oxygenation index, but HFNC can improve patient comfort. For AECOPD patients not tolerant to NPPV therapy after extubation, HFNC can be used as sequential alternative treatment for NPPV.
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