慢性阻塞性肺病（chronic obstructive pulmonary disease，COPD）简称慢阻肺，是一种常见、可预防和治疗的疾病，

具有持续存在的呼吸系统症状和气流受限的特征，通常与明显暴露于有害颗粒或气体引起的气道和/或肺泡异常有关。

慢性呼吸衰竭是COPD的严重并发症之一，慢性呼吸衰竭患者存在低氧血症合并CO2潴留，病情反复发作，且逐渐加重，严重影响患者的生活质量，增加其经济负担。长期家庭氧疗（LTOT）对COPD合并慢性呼吸衰竭的患者，不仅可以提高其生存率及生活质量，而且对患者肺功能的恢复、动脉血及血常规等指标的改善具有重要意义。近年来，加温加湿高流量经鼻导管氧气治 疗（heated and humidified high flow nasal cannula oxygen therapy，HFNC）作为COPD患者的一种新型呼吸支持方式，受到越来越多的重视，也可提倡成为家庭氧疗的一种手段[4]。本研究对确诊为COPD合并慢性呼吸衰竭治疗好转出院的患者进行不同方式的家庭氧疗，旨在分析其治疗效果。

经鼻高流量湿化氧疗在慢性阻塞性肺疾病合并慢性呼吸衰竭家庭氧疗中的疗效分析

蔡博1，俞光胜2，秦剑1，黄晓青2，张云辉3（1.大理大学临床医学院，云南  大理  671000；2.广东省汕头潮南民生医院呼吸科，广东  汕头  515000；云南省第一人民医院呼吸与危重症医学科，云南 昆明 650000）

摘要：目的  探讨经鼻高流量湿化氧疗（High-flow Nasal Cannula，HFNC）在慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）合并慢性呼吸衰竭患者的长期家庭氧疗中的治疗效果。方法 选取2019年3月至2019年8月在大理大学临床学院呼吸科、汕头潮南民生医院呼吸科、云南省第一人民医院呼吸与危重症医学科确诊为慢性阻塞性肺病合并慢性呼吸衰竭治疗好转出院患者87例，随访6个月，根据氧疗情况分为A组（未进行氧疗干预组，n=27），B组（常规鼻导管吸氧组，n=35）和C组（经鼻高流量湿化氧疗治疗组，n=25），观察治疗前后各项指标变化：6min 步行距离（6MWD），改良医学研究学会呼吸困难量表（MMRC），慢性阻塞性肺疾病评估测试（COPDA ssessment Test TM，CAT），动脉血PaO2、PaCO2，血常规（血红蛋白、红细胞压积），肺动脉压力，肺通气功能（FEV1、FEV1占预计值%）。结果治疗后，C组6MWD、MMRC和CAT评分改善效果均优于A、B两组（P＜0.05）；B组6MWD及MMRC改善效果优于A组（P＜0.05），B组CAT评分与A组比较差异无统计学意义。与A组比较，C组治疗后肺动脉压、FEV1、FEV1%pre改善效果明显（P＜0.05），B组FEV1%pre治疗后优于A组（P＜0.05），肺动脉压、FEV1与A组比较差异无统计学意义；C组肺动脉压及FEV1%pre治疗效果明显优于B组（P＜0.05）。治疗后，B、C组血液指标均优于治疗前（P＜0.05），B、C组PaO2、PaCO2治疗效果明显优于A组（P＜0.05），且C组优于B组（P＜0.05）。结论慢性阻塞性肺疾病合并慢性呼吸衰竭患者进行长期家庭氧疗，能明显改善其生活质量、肺通气功能等；而HFNC 比单纯使用低流量给氧具有更大的优势。

关键词：经鼻高流量湿化氧疗；家庭氧疗；慢性阻塞性肺疾病；慢性呼吸衰竭

Analysis of the curative effect of high nasal flow humidification oxygen therapy in the home oxygen therapy of chronic obstructive pulmonary disease with chronic respiratory failure

CAI Bo1, YU Guangsheng2, QIN Jian1, HUANG Xiaoqing2, ZHANG Yunhui3 ( 1. Clinical college of Dali University, Dali, Yunnan, 671000, China; 2. Department of Respiratory, Guangdong province Shantou

Chaonan Minsheng Hospital, Shantou, Guangdong, 515000, China; 3. Department of Respiratory and Critical Care, Yunnan First People’ s Hospital, Kunming, Yunnan, 650000, China)

Abstract:

Objective To observe and analyze the therapeutic effect of High-flow Nasal Cannula (HFNC) in long-term home oxygen therapy for patients with chronic obstructive pulmonary disease combined with chronic respiratory failure. Methods From March 2019 to August 2019, 87 pa- tients diagnosed with Chronic obstructive pulmonary disease with chronic respiratory failure in the department of respiratory sciences, clinical college of Dali University, Chaonan Minsheng Hospital of Shantou, and the First People’ s Hospital of Yunnan province were selected. These patients which were treated better and discharged from the hospital, were divided into group A (no oxygen therapy intervention group, n=27), group B (conventional nasal catheter oxygen group, n=35) and group C (HFNC group, n=25) according to the way they received oxygen. The patients were followed up for 6 months to observe the changes of the indexs before and after treatment: 6 min walking distance (6MWD), improved medical research society dyspnea scale (MMRC), COPD Assessment Test TM (CAT), arterial blood PaO2, PaCO2, blood routine (hemoglobin, hematocrit), pulmonary artery pressure, pulmonary ventilation function (FEV1, FEV1%pre). Results After treatment, the improvement effects of 6MWD, MMRC and CAT scores in group C were better than those of groups A and B (P＜0.05). The improvement effect of 6MWD and MMRC in group B was better than that of group A (P< 0.05). There was no statistically significant difference in CAT scores between group A and B. Compared with group A, pulmonary artery pressure, FEV1, FEV1%pre of group C improved more significantly after treatment (P＜0.05), group B FEV1%pre was better than group A (P＜0.05),there was no significant difference in pulmonary artery pressure and FEV1, the treatment effect of pulmonary artery pressure and FEV1%pre in group C was sig- nificantly better than that in group B (P＜0.05). After treatment, the treatment effect of PaO2  and PaCO2  in group B and C was significantly better than that of group A (P＜0.05), and the treatment effect of group C was significantly better than that of group B (P＜0.05). Conclusion Long-term home oxygen therapy can significantly improve the quality of life and pulmonary ventilation function inpatients with chronic obstructive pulmonary dis- ease (COPD) combined with chronic respiratory failure. HFNC has a greater advantage than simply using low flow oxygen.

Key words: High-flow Nasal Cannula; Home oxygen therapy; Chronic obstructive pulmonary disease; Chronic respiratory failure

当代医学    2021年 1月第 27卷第 1期总第 588期   Contemporary Medicine，Jan.2021，Vol.27 No.1 Issue No.588

声明：转载此文是出于传递更多信息之目的。若有来源标注错误或侵犯了您的合法权益，请作者持权属证明与本网联系（留言或填写联系卡），我们将及时更正或删除，感谢。