Clinical application of nasal high flow cannula in acute exacerbation of chronic obstructive pulmonary disease / 中国医师进修杂志

ABSTRACT

Objective:To explore the clinical value of nasal high flow oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods:From June 2017 to June 2018, 61 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) admitted to the Huxi Hospital (Shanxian Central Hospital) Affiliated to Jining Medical College were taken as the clinical research objects. The patients were divided into control group and treatment group by using the random number table method with 31 patients in control group and 30 patients in treatment group. They all treated with anti-infection, anti-inflammation, expectoration, spasmolysis, asthma relief, anticoagulation and nutritional support. The control group was given conventional low flow oxygen therapy, while the treatment group was given nasal high flow oxygen therapy. The changes of partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), pulmonary artery systolic pressure (PSAP), right ventricular pressure maximum rise rate (dp/dt) and the application rate of non-invasive and invasive mechanical ventilation within 7 d were observed before and 12, 24, 48 and 72 h after treatment. Results:Before treatment, PaO 2, PaCO 2, PSAP and dp/dt of patients in the two groups showed no statistical difference, indicating comparability between groups. Compared with the control group, the PaO 2 in the treatment group decreased at all time points after treatment [(54.37 ± 5.39) mmHg (1 mmHg=0.133 kPa) vs. (57.77 ± 6.06) mmHg, (61.87 ± 5.20) mmHg vs. (65.03 ± 4.91) mmHg, (66.93 ± 6.59) mmHg vs. (72.58 ± 7.13) mmHg, (70.20 ± 8.18) mmHg vs. (75.55 ± 7.37) mmHg, P<0.05]. PaCO 2 decreased [(57.97 ± 6.18) mmHg vs. (61.84 ± 6.20) mmHg, (51.27 ± 4.53) mmHg vs. (55.77 ± 5.87) mmHg, (48.57 ± 5.37) mmHg vs. (51.55 ± 4.62) mmHg, (44.70 ± 5.40) mmHg vs. (47.68 ± 5.86) mmHg, P<0.05]. PSAP all decreased [(50.80 ± 6.94) mmHg vs. (54.55 ± 6.58) mmHg, (48.70 ± 6.22) mmHg vs. (52.55 ± 6.91) mmHg, (45.33 ± 7.51) mmHg vs. (49.19 ± 6.40) mmHg, (41.23 ± 9.22) mmHg vs. (45.94 ± 7.35) mmHg, P<0.05]. Dp/dt all increased [(403.77 ± 109.43) mmHg/s vs. (345.39 ± 112.50) mmHg/s, (429.83 ± 102.56) mmHg/s vs. (369.77 ± 110.55) mmHg/s, (483.43 ± 105.20) mmHg/s vs. (426.48 ± 107.27) mmHg/s, (532.43 ± 107.01) mmHg/s vs. (473.74 ± 105.00) mmHg/s. P<0.05]. The application rate of non-invasive/invasive mechanical ventilation in the treatment group was lower than that in the control group within treated for 7 d ( P<0.05). Conclusions:Transnasal high-flow oxygen therapy has a better clinical effect on patients with chronic obstructive pulmonary disease and is helpful to improve the right heart function.