摘要 目的 探讨经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重（AECOPD）合并Ⅱ型呼吸衰竭的疗效性和安全性。 方法 采用前瞻性研究方法，将入选的AECOPD合并Ⅱ型呼吸衰竭63例患者随机分为HFNC组和无创正压通气 (NPPV)组，其中HFNC组32例，NPPV组31例。HFNC组应用经鼻高流量湿化氧疗，NPPV组应用无创呼吸机辅助通气。两组患者在入选后因各种原因更换为另一种呼吸支持方式或进行气管插管行有创机械通气视为失败。主要观察两组的失败率、气管插管率、并发症、28 d病死率。 结果 HFNC组失败率低于NPPV组(21.9% vs. 29.0％)，差异无统计学意义(P=0.572)。HFNC组气管插管患者为6例（18.8%），NPPV组7例（22.6%），差异无统计学意义(P=0.763)。HFNC组鼻、面部损伤（9.4% vs. 35.5%，P=0.016）和胃、肠胀气（18.8% vs. 48.4%, P=0.017）均少于NPPV组。HFNC组呼吸支持时间长于NPPV组（d：8.63±1.41 vs. 7.48±1.12，P=0.001），而呼吸困难缓解所需时间比NPPV组慢（h：8.25±1.61 vs. 6.10±1.37，P=0.000)。两组住ICU时间（P=0.569）和总住院时间（P=0.122）差异无统计学意义。HFNC组与NPPV组28 d病死率差异无统计学意义（25.0％ vs. 19.4％, P>0.05）。 结论 HFNC治疗AECOPD伴Ⅱ型呼吸衰竭患者是有效和安全的。
王建军，姜宏英，李勍. 经鼻高流量湿化氧疗与无创正压通气治疗慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭的随机对照研究[J]. 中国急救医学, 2019, 39(10): 945-948.
Wang Jian-jun, Jiang Hong-ying, Li Qing. Randomized controlled study of HFNC and NPPV in the treatment of AECOPD combined with type Ⅱ respiratory failure. Chinese Journal of Critical Care Medicine, 2019, 39(10): 945-948.
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