Clinical efficacy of nasal high flow humidifying oxygen therapy for patients with acute exacerbation of bronchiectasis and type II respiratory failure
经鼻高流量湿化氧疗治疗支气管扩张急性加重并II型呼吸衰竭患者的临床疗效探讨

摘要

目的 探讨经鼻高流量湿化氧疗（high-flow nasal cannula oxygen therapy，HFNC）治疗支气管扩张急性加重并II型呼吸衰竭患者的临床疗效。方法 选取2020年7月~2023年1月我院呼吸与危重症医学科收治的40例支气管扩张急性加重并II型呼吸衰竭患者作为研究对象，采用随机数字表法将患者分为传统氧疗组（20例）和HFNC组（20例）。全部患者均予以抗感染、祛痰等常规治疗，传统氧疗组给予鼻导管吸氧，HFNC组给予HFNC治疗。比较两组患者治疗前和治疗后2h、24h和出院前血气分析指标[动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）和氧合指数（PaO2/FiO2）]、呼吸频率、心率、痰液粘稠度和耐受性评分；比较两组患者不良事件发生率和住院时间。结果 治疗后2h、24 h和出院前，两组患者的PaO2、PaO2/FiO2均高于本组治疗前，且HFNC组的PaO2、PaO2/FiO2高于传统氧疗组，差异有统计学意义（P＜0.05）；治疗后24 h和出院前，传统氧疗组的PaCO2低于本组治疗前，差异有统计学意义（P＜0.05）；治疗后2h、24 h和出院前，HFNC组的PaCO2低于本组治疗前，且HFNC组的PaCO2低于传统氧疗组，差异有统计学意义（P＜0.05）。治疗后2h、24 h和出院前，两组患者的呼吸频率和心率均低于本组治疗前，且HFNC组的呼吸频率和心率改善优于传统氧疗组，差异有统计学意义（P＜0.05）。传统氧疗组出院前的痰液粘稠度优于治疗前，差异有统计学意义（P＜0.05）。HFNC组治疗后2h、24h和出院前的痰液粘稠度均优于治疗前，差异有统计学意义（P＜0.05）。HFNC治疗后24小时、出院前的痰液粘稠度优于传统氧疗组，差异有统计学意义（P＜0.05）。HFNC组患者治疗后2h、24h和出院前的耐受性评分均优于传统氧疗组，差异有统计学意义（P＜0.05）。治疗后HFNC组不良事件发生率（鼻咽部干燥、鼻出血）低于传统氧疗组，差异有统计学意义（P＜0.05）；HFNC组住院时间少于传统氧疗组，差异有统计学意义（P＜0.05）。结论 经鼻高流量湿化氧疗治疗支气管扩张急性加重并II型呼吸衰竭患者，其临床疗效确切，较之传统氧疗更快、更好地改善患者血气分析氧合及通气指标，改善患者痰液粘稠度、有利于痰液引流，缩短住院时间，且耐受性更好、舒适性更佳。

Abstract

Objective To investigate the clinical efficacy of high-flow nasal cannula oxygen therapy (HFNC) in the treatment of patients with acute exacerbation of bronchiectasis and type II respiratory failure.
Methods A total of 40 patients with acute exacerbation of bronchiectasis and type II respiratory failure admitted to the Department of Respiratory and Critical Care Medicine of our hospital from July 2020 to January 2023 were selected as the study objects. The patients were divided into traditional oxygen therapy group (20 cases) and HFNC group (20 cases) by random number table method. All patients were given anti-infection, expectorant and other conventional treatment, the traditional oxygen therapy group was given nasal catheter oxygen, HFNC group was given HFNC treatment. Blood gas analysis indexes (arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and oxygenation index (PaO2/FiO2)), respiratory rate, heart rate, sputum viscosity and tolerance scores were compared between the two groups before treatment, 2h after treatment, 24h after treatment and before discharge. The incidence of adverse events and length of hospital stay were compared between the two groups.
Results 2h, 24 h after treatment and before discharge, PaO2 and PaO2/FiO2 in 2 groups were higher than before treatment, and PaO2 and PaO2/FiO2 in HFNC group were higher than those in traditional oxygen therapy group, with statistical significance (P < 0.05). At 24 h after treatment and before discharge, PaCO2 in traditional oxygen therapy group was lower than that before treatment, and the difference was statistically significant (P < 0.05). PaCO2 in the HFNC group was lower than that before treatment 2h, 24h after treatment and before discharge, and PaCO2 in the HFNC group was lower than that in the traditional oxygen therapy group, the difference was statistically significant (P < 0.05). 2h, 24 h after treatment and before discharge, the respiratory rate and heart rate of patients in 2 groups were lower than before treatment, and the improvement of respiratory rate and heart rate in HFNC group was better than that in traditional oxygen therapy group, the difference was statistically significant (P < 0.05). The phlegm viscosity of traditional oxygen therapy group before discharge was better than that before treatment, and the difference was statistically significant (P < 0.05). The sputum viscosity of HFNC group at 2h, 24h after treatment and before discharge was better than that before treatment, the difference was statistically significant (P < 0.05). The phlegm viscosity of HFNC 24 hours after treatment and before discharge was better than that of traditional oxygen therapy group, and the difference was statistically significant (P < 0.05). The tolerance scores of HFNC group were better than those of traditional oxygen therapy group 2h, 24h after treatment and before discharge, and the difference was statistically significant (P < 0.05). After treatment, the incidence of adverse events (nasopharyngeal dryness and epistaxis) in HFNC group was lower than that in traditional oxygen therapy group, and the difference was statistically significant (P < 0.05). The length of hospital stay in HFNC group was less than that in traditional oxygen therapy group, and the difference was statistically significant (P < 0.05).
Conclusion   Nasal high-flow humidification oxygen therapy in the treatment of patients with acute exacerbation of bronchiectasis and type II respiratory failure has definite clinical efficacy. Compared with traditional oxygen therapy, it can improve blood gas analysis oxygenation and ventilation indexes faster and better, improve sputum viscosity, facilitate sputum drainage, shorten hospital stay, and be better tolerated and comfortable.