目的 对比经鼻高流量湿化氧疗（high-flow nasal cannula oxygen therapy， HFNC）与无创机械通气（non-invasive positive pressure ventilation， NPPV）在治疗高龄慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease， AECOPD）合并轻中度高碳酸血症患者的疗效。 方法 选取2021年8月至2023年10月在中国人民解放军总医院第二医学中心收治的AECOPD合并高碳酸血症患者92例，NPPV组49例，HFNC组43例。比较两组的28 d气管插管率、90 d病死率及动脉血气改善情况。 结果 NPPV组28 d插管率显著高于HFNC组（28.57% vs. 11.63%，P < 0.05），而两组90 d病死率差异无统计学意义（36.73% vs. 23.26%，P > 0.05）。Kaplan-Meier生存分析显示，HFNC组28 d插管率显著低于NPPV组（Log-Rank检验：χ² = 4.257，P = 0.039）；两组的90 d病死率差异无统计学意义（Log-Rank检验：χ² = 2.596，P = 0.107）。Cox比例风险模型分析显示，在校正APACHE Ⅱ评分和基线PaCO₂后，与NPPV组比较，HFNC组28 d插管风险降低69%（HR = 0.31，95%CI：0.10 ~ 0.93，P = 0.037）；而90 d死亡风险无显著降低（HR = 0.61，95%CI：0.27 ~ 1.37，P = 0.232）。两组患者治疗后PaCO₂均较基线逐渐下降、pH值同步上升，2 h和48 h的PaCO₂、pH值、PaO₂分别与基线值比较，变化幅度差异均无统计学意义（P > 0.05）。 结论 对于高龄AECOPD合并轻中度高碳酸血症患者，HFNC较NPPV能降低气管插管率，同时不增加病死率，对动脉血气指标的改善效果相仿，可以作为适宜的呼吸支持方式。

Objective To evaluate the clinical efficacy of high-flow nasal cannula oxygen therapy （HFNC） versus non-invasive positive pressure ventilation （NPPV） in elderly patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） accompanied by mild to moderate hypercapnia. Methods The study included 92 AECOPD patients with hypercapnia treated at the second medical center of Chinese PLA General Hospital from August 2021， to October 2023， with 49 in the NPPV group and 43 in the HFNC group. The two groups were compared in terms of 28-day intubation rate， 90-day mortality， and arterial blood gases. Results The NPPV group showed a significantly higher 28-day intubation rate compared to the HFNC group （28.57% vs. 11.63%， P < 0.05）， but no significant differences in the 90-day mortality rate （36.73% vs. 23.26%， P > 0.05）. The Kaplan-Meier curve indicated that the HFNC group had a significantly lower 28-day intubation rate compared to the NPPV group （Log-Rank test： χ² = 4.257， P = 0.039）， but no significant difference in 90-day mortality rate （Log-Rank test： χ² = 2.596， P = 0.107）. A Cox proportional hazards model， which incorporated APACHE II score and baseline PaCO₂， demonstrated that the risk of 28-day intubation in the HFNC group was reduced by 69% as compared to the NPPV group （HR = 0.31， 95%CI：0.10 ~ 0.93， P = 0.037）， but the risk of 90-day mortality did not show a significant decrease （HR = 0.61， 95%CI：0.27 ~ 1.37， P = 0.232）. PaCO₂ in both groups decreased gradually and pH increased simultaneously. PaCO₂， pH， and PaO₂ at 2h and 48h against the baseline values did not differ significantly between the two groups （P > 0.05）. Conclusion In elderly AECOPD patients with mild-to-moderate hypercapnia， HFNC reduces intubation rates compared to NPPV， without increasing mortality， and shows similar improvements in arterial blood gas indicators， making it a suitable respiratory support option.