Sequential treatment of chronic obstructive pulmonary disease concurrent with respiratory failure by high-flow nasal cannula therapy

摘要

Objective: To analyze the efficacy of sequential treatment with high-flow nasal cannula (HFNC) in chronic obstructive pulmonary disease (COPD) concomitant with respiratory failure. Methods: A total of 100 COPD patients concomitant with respiratory failure requiring invasive mechanical ventilation from June 2019 to May 2020 in our hospital were enrolled and then divided into two groups according to the random number table, with 50 in each group. Pulmonary infection control window (PIC) was used as a switching point for sequential ventilation. The control group (CNG) received non-invasive positive pressure ventilation (NIPPV), while the study group (SG) underwent HFNC. The efficacy, complications and 48 h reintubation rate of the two groups were statistically analyzed. The respiratory parameters, diaphragmatic parameters, diaphragmatic excursion during quiet breathing (DEq), diaphragmatic rapid shallow breathing index (D-RSBI), COPD score (CAT), 6-min walk test (6 MWT) score (Borg), General Comfort Questionnaire (GCQ), sputum viscosity, and serum factors were observed before intubation and after 48 hours of intubation. Results: The overall response rate (94.00%) in SG was higher than that in CNG (80.00%) ( P 0.05); SG had lower RR, PaCO 2 and D-RSBI at 48 hours after extubation and higher PaO 2 /FiO 2 and DEd than CNG ( P 0.05); SG exhibited lower CAT and Borg at 48 hours after extubation and higher GCQ score than CNG ( P 0.05); SG had lower sputum viscosity at 48 hours after extubation than CNG ( P 0.05); SG showed lower ET-1, NLR and NT-proBNP levels at 48 hours after extubation than CNG ( P 0.05). Conclusion: HFNC sequential therapy is effective and safe in the treatment of COPD concomitantly with respiratory failure. It can improve respiratory function and diaphragmatic function, reduce dyspnea and fatigue, reduce sputum viscosity, regulate serum factors, and make patients enjoy higher comfort.