慢性阻塞性肺疾病患者有创通气拔管后序贯经鼻高流量氧疗-无创正压通气交替治疗的效果观察

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Abstract Objective To explore the clinical effect of the alternating treatment of sequential high-flow nasal cannula(HFNC)-non-invasive positive pressure ventilation (NIPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with type 2 respiratory failure after invasive mechanical ventilation. Methods A total of 98 patients with AECOPD with type 2 respiratory failure after invasive mechanical ventilation admitted to the First Affiliated Sanming Hospital of Fujian Medical University from January 2018 to January 2020 were selected as research objects. To take the "pulmonary infection control window" as the switching point, the patients were divided into noninvasive group (n=49) and joint group (n=49) according to the random number table method, non-invasive group was treated with NIPPV , and the joint group was treated with alternating treatment of HFNC-NIPPV. The PaO2 and PaCO2 indexes, viscosity of sputum, degree of comfort, intensive care unit stay time, reintubation rate, incidence of adverse reactions and mortality were compared between the two groups. Results There were no significant differences between the two groups in PaO2 and PaCO2 before treatment (P>0.05). After treatment, the PaO2 index of the joint group was higher than that before treatment and that of the non-invasive group, and the PaCO2 index of the joint group was lower than that before treatment and that of the non-invasive group, the differences were statistically significant (P<0.05). There was no significant difference in the viscosity of sputum before treatment between the two groups (P>0.05). After treatment, the viscosity of sputum of the joint group was higher than that before treatment and that of the non-invasive group, the differences were statistically significant (P<0.05). After treatment, the joint group comfort scores were higher than the noninvasive group, and the differences were statistically significant (P<0.05). After treatment, the intensive care unit stay time, reintubation rate, incidence of adverse reactions and mortality in the joint group were lower than those in the non-invasive group, and the differences were statistically significant (P<0.05). Conclusion For AECOPD patients with type 2 respiratory failure after invasive mechanical ventilation, compared with NIPPV treatment, alternating treatment of HFNC-NIPPV improves the patient′s hypoxia and carbon dioxide retention while improving the degree of comfort, reduces sputum viscosity, incidence of adverse reactions and mortality, shortening the patient′s intensive care unit stay time. The security is high, the clinical curative effect is good, has the medical value, it is worth popularizing vigorously.

Key words： High-flow nasal cannula Non-invasive positive pressure ventilation Chronic obstructive pulmonary disease Clinical efficacy Impact

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ZHANG Zu-qin. Effect observation of the alternating treatment of sequential high-flow nasal cannula and non-invasive positive pressure ventilation in patients with chronic obstructive pulmonary disease after invasive mechanical ventilation[J]. 中国当代医药, 2021, 28(16): 21-24转35.

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http://dangdaiyiyao.com/EN/ OR http://dangdaiyiyao.com/EN/Y2021/V28/I16/21

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