Objective: To investigate and compare the effect and safety of nasal high-flow oxygen therapy (HFNCO) and noninvasive ventilation (NIV) therapy after extubation in patients with chronic obstructive pulmonary disease (COPD). Methods: All COPD patients subjected to mechanical ventilation in the Emergency Intensive Unit of the First Affiliated Hospital of Zhejiang University during January 2015 to June 2016 were included in the study. The patients were divided into two groups after extubation and HFNCO and NIV were adopted on each group respectively. Clinical indexes including the patients' general condition, blood gas analysis and pulmonary function before and after extubation, ratio of re-intubation and CT grades were collected and analyzed. Results: There was no significant difference in the incidence of aspiration (4.8% vs 8.3%), pressure sores (0 vs 8.3%) and delirium (4.8% vs 12.5%) between the two groups (all P>0.05). At 12 h after extubation, the oxygenation index of NIV group was significantly higher than that of the HFNCO group (265±29 vs 297±33; P<0.05), while no significant difference in PCO(2) (P>0.05). For 24 h and 72 h after extubation, there was no statistically significant difference in oxygenation index and PCO(2) between the both groups (P>0.05). The intensive care unit (ICU) retention time in HFNCO group was significantly lower than that in NIV group (13.7±0.8 vs 15.2±0.5; P<0.05). In addition, no significant difference between the two groups in mortality and re-intubation rate at 28 d (P>0.05) was observed. Conclusion: HFNCO is effective and safe in the treatment of COPD patients after extubation, and it is hence valuable for further clinical application.
目的： 探讨慢性阻塞性肺疾病(简称慢阻肺)患者拔管后序贯经鼻高流量氧疗效果及安全性。 方法： 选择浙江大学医学院附属第一医院急诊监护室(EICU)2015年1月至2016年6月收住的符合条件的45例需机械通气的慢阻肺患者，按随机数字表法所有患者拔除气管插管后分别采用序贯应用经鼻高流量氧疗(高流量组21例)和无创机械通气(无创组24例)进行治疗，并对两组患者的一般情况、精神状态、谵妄状态、拔管前后肺功能及血气分析(氧合指数、PCO(2))、再插管率等临床指标进行对比分析。 结果： 两组患者在误吸(4.8%比8.3%)、压疮(0比8.3%)、谵妄(4.8%比12.5%)发生率方面差异均无统计学意义(均P>0.05)；拔管后12 h无创组氧合指数显著高于高流量组(265±29比297±33；P<0.05)，而PCO(2)两组间差异无统计学意义(P>0.05)；拔管后24、72 h两组氧合指数、PCO(2)差异均无统计学意义(均P>0.05)；高流量组重症监护室停留时间明显低于无创组(13.7±0.8比15.2±0.5；P<0.05)；28 d病死率、再插管率两组间差异无统计学意义(P>0.05)。 结论： 经鼻高流量氧疗在慢阻肺患者拔管后序贯治疗中疗效确切，安全可靠，可在临床中推广应用。.
Keywords: Catheterization, peripheral; Oxygen inhalation therapy; Pulmonary disease, chronic obstructive; Treatment outcome.