Study On The Effect Of High-flow Nasal Cannula Oxygen Therapy On Blood Gas Analysis In Patients With Copd Complicated With Hypercapnia

Objective:To evaluate the effect of high-flow nasal cannula oxygen therapy?HFNC?under different flow parameters on the blood gas analysis in patients with chronic obstructive pulmonary disease?COPD?complicated with mild to moderate hypercapnia?50mmHg?PaCO₂?80mmHg?.Methods:All chronic obstructive pulmonary disease patients with mild to moderate hypercapnia subjected to The First People's Hospital of Xiangtan City during January 2018 to December 2018 were included in the study.All the patients were unable to tolerate or refused to be use noninvasive ventilation.Prior to the start of the study,participants were trained in knowledge about COPD and related treatment cautions in this study.The patients were divided into two groups according to random number table and their willingness:35 patients in the experimental group were treated with nasal high-flow oxygen therapy and 35 patients in the control group were treated with Traditional nasal oxygen therapy.Both groups were given conventional treatments such as anti-infection,spasmolytic,electrolyte imbalance rectification phlegm-resolving,and airway inflammation inhibition.The control group was treated with traditional nasal oxygen therapy,parameter Settings:oxygen flow less than3.5 L/min,oxygen concentration?%?=21+4*oxygen flow?L/min?,which less than 35%,and daily treatment should be more than 15 hours.The experimental group was treated with nasal high-flow oxygen therapy,parameter Settings:temperature of 37?and relative humidity of 100%,oxygen concentration?%?less than 35%,and daily treatment should be more than 15 hours.Clinical indexes including the patients'general condition,blood gas analysis,Visual analogue scale,and ratio of intubation were collected.The experimental group was divided into three groups according to the PaCO₂ before treatment.Group A:50mmHg?PaCO₂ before treatment?60mmHg;Group B:61mmHg?PaCO₂before treatment?70mmHg;Group C:71mmHg?PaCO₂ before treatment?80mmH;Comparing different interval PaCO₂ decline in value,find the best PaCO₂ improvement interval in different intervals.The high-flow oxygen therapy device were set as 30min/L,40min/L and50min/L.Comparison of different oxygen flow rate PaCO₂ improvement,finding the best flow set parameters.All data were analyzed by SPSS22.0.Results:1.There was no significant difference in heart rate,blood pressure,age,PaCO₂,PaO₂,SaO₂ between the two groups before treatment?P>0.05?;There were significant difference in PaO₂ at 2h and at 2h after treatment?P<0.05?.2.There were significant difference in PaCO₂ at each time point after treatment between the two groups?P<0.05?.PaCO₂ in the control group was not significantly improved at 2h?24h and 48h after treatment?P>0.05?,and PaO₂,SaO₂ were significantly improved after treatment?P<0.05?;In the experimental group,PaCO₂ was improved at24h and 48h after treatment?P<0.05?;There were significantly improved at 2h?24h and 48h in PaO₂ and SaO₂ after treatment?P<0.05?.3.PaCO₂ value before treatment in the range of 61mmHg-80mmHg was more obvious than 50mmHg-60mmHg range in the experimental group.In a certain range,the parameter is set to 50L/min,PaCO₂improved significantly,and the difference was statistically significant?P<0.05?.4.The comfort level of patients in the experimental group was better,and the difference was statistically significant?P<0.05?.5.There was no significant difference in trachea cannula ratio between the two groups?P>0.05?.Conclusion:1.HFNC can improve PaO₂,SaO₂ and PaCO₂ on chronic obstru-ctive pulmonary disease patients with mild-moderate hypercapnia;2.It is safe and effective that high flow oxygen therapy does not increase the risk of CO₂ retention and trachea cannula ratio.To a certain extent,it is suitable for patients with COPD combined with hypercapnia who do not tolerate noninvasive ventilation;3.High flow oxygen therapy is comfortable.