高流量鼻氧插管与常规氧疗对适应长期氧疗的COPD患者的影响:一项随机交叉研究

Q4 Medicine

Journal of the Medical Association of Thailand = Chotmaihet thangphaet Pub Date : 2023-05-15 DOI:10.35755/jmedassocthai.2023.05.13848

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引用次数: 0

摘要

背景:长期氧疗(LTOT)被推荐用于稳定型慢性阻塞性肺疾病(COPD)伴严重静息低氧血症患者。高流量鼻氧插管(HFNC)证明了急性低氧性呼吸衰竭的益处。HFNC通过清除死腔和减少呼吸功的机制也可能对有LTOT指征的COPD患者有益。目的:比较HFNC与常规氧疗(COT)在呼吸频率、气体交换和健康相关生活质量方面的影响。材料和方法:在11例稳定期COPD患者中进行了一项随机交叉试验。受试者被随机分配至流量为30l /分钟的HFNC组或流量为2 ~ 4l /分钟的简单鼻插管组，以交叉方式持续两周。主要观察指标为呼吸频率。次要结局包括血压、心率、血氧饱和度(SpO₂)、经皮二氧化碳压(PtcCO₂)和圣乔治呼吸问卷(SGRQ)评分。结果:HFNC和COT使用时间分别为8 (IQR 3 ~ 13)和14 (IQR 10 ~ 20) h /d (p=0.039)。HFNC组呼吸频率明显低于COT组，分别为18次/分钟(IQR 16 ~ 20)和22次/分钟(IQR 20 ~ 25) (p=0.018)。与COT相比，HFNC组的SpO₂明显升高(p=0.046)。两组患者血压、心率、PtcCO₂、SGRQ评分均无差异。未观察到HFNC的严重不良事件。结论:目前的初步研究表明，对于有LTOT指征的稳定型COPD患者，HFNC是可耐受的。与COT相比，HFNC组呼吸频率明显降低，SpO₂明显升高。需要另一项更大样本量的研究来进一步阐明HFNC对稳定期COPD患者的疗效。关键词:慢性阻塞性肺疾病;呼吸困难;高流量鼻插管;氧气疗法;呼吸速率

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The Effect of High Flow Nasal Oxygen Cannula Versus Conventional Oxygen Therapy in COPD Patients with Indication for Long-term Oxygen Therapy: A Pilot Randomized Crossover Study

Background: Long-term oxygen therapy (LTOT) is recommended to be used in stable chronic obstructive pulmonary disease (COPD) patients with severe resting hypoxemia. High-flow nasal oxygen cannula (HFNC) demonstrated benefits in acute hypoxemic respiratory failure. The mechanisms of HFNC by washing out dead space and decreasing work of breathing may be also beneficial in COPD patient who has an indication for LTOT. Objective: To compare the effect of HFNC versus conventional oxygen therapy (COT) in terms of respiratory rate, gas exchange, and health-related quality of life. Materials and Methods: A pilot randomized crossover study was conducted in eleven stable COPD patients. Subjects were randomly assigned to HFNC at a flow rate of 30 L/minute or simple nasal cannula at 2 to 4 L/minute for two weeks in a cross-over fashion. The primary outcome was respiratory rate. The secondary outcomes included blood pressure, heart rate, oxygen saturation (SpO₂), transcutaneous carbon dioxide pressure (PtcCO₂), and St.George’s Respiratory Questionnaire (SGRQ) score. Results: The duration of HFNC and COT use was 8 (IQR 3 to 13) and 14 (IQR 10 to 20) hours/day, respectively (p=0.039). Respiratory rate was significantly lower with HFNC compared to COT at 18 breaths/minute (IQR 16 to 20) versus 22 breaths/minute (IQR 20 to 25) , respectively (p=0.018). SpO₂ was significantly higher with HFNC compared to COT (p=0.046). No differences in blood pressure, heart rate, PtcCO₂, and SGRQ score were observed between the two groups. No serious adverse event from HFNC was observed. Conclusion: The present pilot study demonstrated that HFNC was tolerable in patients with stable COPD who had an indication for LTOT. Respiratory rate was significantly lower and SpO₂ was significantly higher with HFNC compared to COT. Another study with larger sample size is needed to further clarify the efficacy of HFNC in stable COPD patients. Keywords: Chronic obstructive pulmonary disease; Dyspnea; High-flow nasal cannula; Oxygen therapy; Respiratory rate

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来源期刊

Journal of the Medical Association of Thailand = Chotmaihet thangphaet Medicine-Medicine (all)

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0.40

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0.00%

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