关键词: 肺疾病, 慢性阻塞性, 正压呼吸, 呼吸, 人工, 急性病生理学和长期健康评价

Abstract: Objective　To evaluate the therapeutic efficacy of high-flow nasal cannula（HFNC） and noninvasive positive-pressure ventilation（NPPV） in patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD） and various APACHE Ⅱ scores after extubation.Methods　We enrolled 120 patients with AECOPD undergoing tracheal intubation in the Department of Critical Care Medicine，Wuhan First Hospital from December 2014 to November 2016.All patients were assigned to either Group A（APACHE Ⅱ score <12），B（APACHE Ⅱ score of 12 to 24） or C（APACHE Ⅱ score >24） according to the APACHE Ⅱ score，with 40 cases in each group.The patients in each group were then divided into Subgroups Ⅰ（undergoing HFNOT，n=20） and Ⅱ（undergoing NPPV，n=20） using a random number table.The patients' general characteristics were recorded，along with the respiratory parameters and the incidence of endpoints and complications.Results　There were no interactionswith pH value，oxygenation index（OI），partial pressure of carbon dioxide（PaCO2），respiratory rate（RR） and blood lactic acid（Lac） concentration in Group A in terms of the treatment option and duration（P>0.05），and the main effect was not significant in relation to pH value，OI，PaCO2，RR or blood Lac concentration in terms of the treatment option and duration（P>0.05）．In addition，there was no significant difference in the occurrence rate of re-intubation and atelectasis between Subgroups Ⅰ and Ⅱ in Group A（P>0.05），and a significantly lower incidence rate of abdominal distention was seen in Subgroup Ⅰ compared with Subgroup Ⅱ（P<0.05）．In Group B，there were no interactions with pH value，OI，RR or blood Lac concentration in terms of the treatment option and duration（P>0.05），and an interaction was seen with PaCO2（P<0.05），while the main effect was not significant in relation to pH value，OI，RR or blood Lac concentration in terms of the treatment option and duration（P>0.05），but significant in relation to PaCO2（P<0.05）．In addition，the occurrence rate of re-intubation was not significant difference in Subgroup Ⅰ and Subgroup Ⅱ（P>0.05），and a significantly lower incidence rate of abdominal distention and atelectasis was seen in Subgroup Ⅰ compared with Subgroup Ⅱ（P<0.05）．In Group C，there were no interactions with pH value or blood Lac concentration in terms of the treatment option and duration（P>0.05），and there were interactions with OI，PaCO2 and RR（P<0.05）．The main effect was not significant in relation to pH value or blood Lac concentration（P>0.05），but significant in relation to OI，PaCO2 and RR（P<0.05），in terms of the treatment option and duration.Moreover，the occurrence rate of re-intubation was significantly higher in Subgroup Ⅰ than in Subgroup Ⅱ（P<0.05），and a significantly lower incidence rate of abdominal distention and atelectasis was seen in Subgroup Ⅰ compared with Subgroup Ⅱ（P<0.05）．Conclusion　There was no significant difference in the preventive efficacy of sequential therapy with HFNC and NPPV for respiratory failure in elderly AECOPD patients with APACHE Ⅱ scores of <24 after extubation；however，the preventive efficacy of HFNC was inferior to NPPV for respiratory failure in elderly AECOPD patients with APACHE Ⅱ scores of > 24 after extubation.

Key words: Pulmonary disease, chronic obstructive；Positive-pressure respiration；Respiration, artificial；APACHE