The Effect Of High Flow Nasal Cannula On Patients With Ⅱ Respiratory Failure Due To Chronic Obstructive Pulmonary Disease

Objective: Chronic Obstructive Pulmonary Disease(Chronic Obstructive Pulmonary Disease,COPD) is a kind of progressive disease characterized with not fully reversible airflow limitation,which related from pulmonary’s abnormal inflammatory response to harmful gas or particle.In addition,the COPD can also cause adverse effects in extrapulmonary tissues and organs. Acute exacerbation of the COPD often lead to type Ⅱ of respiratory failure and the the latter’s incedence and mortality rate is very high.The treatment should not only include control of the clinical infection,relief of the airway,cough expectorant,correcting water electrolyte and acid-base imbalance,but also should actively improve oxygenation and correct respiratory failure.Traditional way of oxygen uptaken has many shortcomings such as that the oxygen is too dry,it’s can’t effectively adjust the oxygen concentration,and others.Dry oxygen in patients will lead to nasal mucosa’s scabby,bleeding,and it’s also likely to affect the sputum excretion.Nasal high flow and temperature humidity oxygen(high flow nasal cannula,HFNC) is a noninvasive respiratory support mode improved from oxygen inhalation through nasal catheter,which has been widely applied in foreign countries in recent yesrs.The new mode uses the closed duct flow which is greater than 1 l/min oxygen mixed gas to generate positive pressure,so as to improve the ventilation function.Airtight pipeline will prevent moisture loss,airway cooling,respiratory secretions accumulated,and reduce the stimulus to the nose.This study is to explore the value of HFNC in the treatment of patients with COPD and type Ⅱ respiratory failure by comparing the effect of HFNC with conventional nasal catheter low flow oxygen therapy,which will provide a new kind of noninvasive ventilation mode to treat the patients with COPD and typeⅡ respiratory failure.Methods: The 54 patients with COPD andtypeⅡ respiratory failure who were selected from january 2015 to December 2015 in the respiratory ward were randomly divided into observation group and control group that both of the group had 27 cases.The two groups’ data like age,gender,duration of the disease has no instaistic difference(P>0.05).The control group were given routine therapy including control infection,relife the airway,expectorant, correctting the water electrolyte and acid-base imbalance,short-range using glucocorticoid, nutritional support treatment,and nasal catheter oxygen therapy with the oxygen flow rate maintained at 1~2L/min. The observation group used Optiflow nasal high Flow rate and temperature humidity oxygen cure system(New Zealand Fisher Paykel company) implementation of high flow oxygen therapy with inhaled oxygen concentration 25%~40%, flow 20~40 l/min,37℃ and 100% relative humidity gas on the basis of conventional therapy.We would adjust the parameters according to the results of the patients with clinical manifestations and blood gas analysis.To compare the clinical efficacy of two groups,we had observed clinical symptoms and the change of main physiological indexes statistics like arterial blood oxygen partial pressure(terial oxygen recogniton,PaO2),arterial blood CO2 partial pressure(arterial carbon dioxide recognition,PaCO2),arterial blood pH value,respiratory frequency(breathing rate, RR) and heart of rate(HR) of two groups in 2 hours before the treatment and 2h, 1d,3d after the treatment.Results: the physiological indexes comparison: after treatment for 3 days,the observation group 18 cases were markedly improved,effective 7 cases,ineffe- ctive in 2 cases,the total effective rate was 92.6%; The control group,12 cases were markedly improved in 7 cases,8 cases ineffective,the total effective rate was 70.4%.The treatment curative effect of observation group was obviously superior to control group,compare the difference was statistically significant(P<0.05).Physiological indexes comparison: the two groups had no statistical significance(P>0.05) in PaO2, PaCO2,blood pH value,RR and HR before treatment.After 2 hours of treatment,the observation group’s clinical symptoms(dyspnoea) improved obviously,the observation group has statistical significance(P<0.05) in PaO2,PaCO2,pH value,RR,HR after 2 hours of the treatment compared with the control one,The observation group’s PaO2,PaCO2,pH value,RR,HR value had statistical significance(P<0.05) compared with the control one after 3days of the treatment.Both groups’ PaO2,PaCO2,pH,RR,HR has statistical significance(P<0.05) compared with no treatment.Treatment effect comparison:There is 1 case in observation group that has intubation, and intubation rate is 3.7%(1/27); Length of hospital stay is(22+11) days.There is 1 death case,and fatality rate is 3.7%(1/27).There aer 7 cases in the Control group that have intubation,and intubation rate is 25.9%(7/27); Length of hospital stay is(29+13) days.And 3death cases,and the fatality rate was 11.1%(3/27).The length of hospial time,intubation rate of the observation group is obviously less than the control one,and the difference is statistically significant(P<0.05).Conclusion: Nasal high flow and temperature humidity oxygen based on conventional therapy can effectively relieve the symptom of patients that suffer COPD with type Ⅱ respiratory failure.And the therapy can rapidly improve their oxygenation status,with no carbon dioxide retention increasing early,and it can gradually corrective carbon dioxide retention with the therapy going on.High-flow nasal oxygen therapy plus temperature and humidity can reduce the intubation rate and shorten hospital stay to promote early recovery of patients.But it can not affect the mortality of patients.It also can administered by HFNC when patients with COPD and acute respiratory failure and the seizures and incentives is not clear.Then we should observe the oxygen saturation changes.When we increase the oxygen concentration, the therapeutic is not effctive,then we should should take mechanical ventilation timely.