探讨无创正压通气与经鼻高流量氧疗（HFNC）动态切换的改良呼吸支持策略在慢性阻塞性肺疾病急性加重（AECOPD）合并Ⅱ型呼吸衰竭患者中的疗效。

将2021年至2023年入住华中科技大学协和深圳医院ICU的68例AECOPD合并Ⅱ型呼吸衰竭患者分为试验组（34例）和对照组（34例），试验组患者采用改良呼吸支持策略，在治疗后2、6、12及24 h动态调整为经鼻高流量氧疗或无创通气，对照组采用经鼻高流量氧疗与无创通气交替使用6 h的治疗方案。比较两组患者的动脉血二氧化碳分压（PaCO₂）及下降水平、pH值、氧合指数、心率、呼吸频率、血压、无创通气使用时长、呼吸困难评分、舒适度评分、膈肌运动度及28 d存活率等。

两组患者基线水平无明显差异，在各研究时间点获取的PaCO₂、pH值、PaO₂、氧合指数及心率、呼吸、血压差异无统计学意义（P>0.05）。试验组在24 h内的无创通气时间明显低于对照组（4.53±8.10比12.00±0.00，P<0.001），且试验组呼吸困难评分更低、舒适度更高（P值分别为0.003，0.010）。

在AECOPD合并Ⅱ型呼吸衰竭患者的治疗中，改良呼吸支持策略不但能有效降低PaCO₂，而且还可以减少无创正压通气的使用时长，减轻患者呼吸困难症状，增加患者舒适性。

To investigate the efficacy of a modified respiratory support strategy on patients with chronic obstructive pulmonary disease (AECOPD) combined with type II respiratory failure.

Sixty-eight patients with AECOPD combined with type II respiratory failure who were admitted to the ICU of Huazhong University of Science and Technology Union Shenzhen Hospital in 2021-2023 were categorized into an intervention group (34 patients) and a control group (34 patients). Patients in the intervention group were treated with a modified respiratory support strategy that was dynamically adjusted to either high-flow oxygen therapy or noninvasive ventilation at 2、6、12 and 24 h post-treatment, and the control group was treated with a treatment regimen that alternated between high-flow oxygen therapy and noninvasive ventilation for 6 h. The partial pressure of arterial blood carbon dioxide (PaCO₂) and the level of decline, pH, oxygenation index, heart rate, respiratory rate, blood pressure, duration of noninvasive ventilation, dyspnea score, comfort score, diaphragm movement and 28-day survival rate were compared between the two groups.

There were no significant differences in baseline characteristics between the two groups, and the differences in PaCO₂, pH, PaO₂, oxygenation index, and heart rate, respiration rate, and blood pressure obtained at any of the study time points were not statistically significant (P>0.05). The duration of noninvasive ventilation in the intervention group was significantly lower than that in the control group over a 24 h period (4.53±8.10 vs. 12.00±0.00, P<0.001), and the intervention group had lower dyspnea scores and higher comfort scores (P=0.003, 0.010, respectively).

In the treatment of patients with AECOPD combined with type II respiratory failure, the modified respiratory support strategy not only effectively reduces PaCO₂, but also decreases the duration of noninvasive positive pressure ventilation, alleviates the symptoms of dyspnea, and improves patient comfort.