经鼻高流量氧疗与无创正压通气在间质性肺炎急性呼吸衰竭中的对比研究

Comparative study of transnasal high flow oxygen therapy and noninvasive positive pressure ventilation in acute respiratory failure with interstitial pneumonia

目的分析经鼻高流量氧疗(HFNC)与无创正压通气(NIPPV)在间质性肺炎急性呼吸衰竭治疗中的应用效果。方法选取山东省胸科医院2018年11月至2020年9月124例间质性肺炎急性呼吸衰竭患者,采用计算机随机分组方法分成试验组和对照组,各62例。试验组男42例,女20例,年龄(62.46±5.79)岁;对照组男40例,女22例,年龄(61.95±6.02)岁。试验组采取HFNC方法治疗,对照组采用NIPPV治疗。对比两组的临床疗效、安全性以及预后相关指标。结果试验组治疗总有效率高于对照组[95.16%(59/62)比80.65%(50/62)],差异有统计学意义(χ^(2)=6.143,P=0.013);治疗后两组患者的心率、呼吸频率明显下降,且治疗后2 h、12 h、24 h和48 h试验组的心率、呼吸频率均低于对照组(均P<0.05);治疗后2 h、12 h、24 h和48 h两组的血氧分压、动脉血二氧化碳分压和血氧饱和度、超氧化物歧化酶和丙二醛水平均优于治疗前,且试验组各指标水平均优于对照组(均P<0.05);试验组的ICU停留时间和住院时间均较对照组短,气道护理干预频次、插管率以及并发症总发生率均低于对照组(均P<0.05)。结论间质性肺炎急性呼吸衰竭临床治疗中,HFNC和NIPPV治疗均能够取得较为显著的治疗效果,HFNC能够更加显著地改善患者的血气分析状况,且治疗安全性和患者预后恢复较好。

Objective To analyze the application effects of transnasal high flow oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)in the treatment of acute respiratory failure with interstitial pneumonia.Methods A total of 124 patients with acute respiratory failure with interstitial pneumonia were selected in Shandong Provincial Chest Hospital from November 2018 to September 2020,and were randomly divided into an experimental group and a control group,with 62 cases in each group.There were 42 males and 20 females in the experimental group,with an age of(62.46±5.79)years old;there were 40 males and 22 females in the control group,with an age of(61.95±6.02)years old.The control group was treated with NIPPV,and the experimental group was treated with HFNC.The clinical efficacies,safety,and prognostic indicators of the two groups were compared.Results The total effective rate of the experimental group was higher than that of the control group[95.16%(59/62)vs.80.65%(50/62)](χ^(2)=6.143,P=0.013).After the treatment,the heart rates and respiratory rates of the two groups decreased significantly,and the heart rates and respiratory rates of the experimental group were lower than those of the control group 2 h,12 h,24 h,and 48 h after the treatment(all P<0.05).Blood gas analysis indexes such as blood oxygen partial pressure,arterial partial pressure of carbon dioxide,and blood oxygen saturation,as well as oxidative stress indexes such as serum superoxide dismutase and serum malondialdehyde of the two groups 2 h,12 h,24 h and 48 h after the treatment were better than those before the treatment,and the indexes in the experimental group were better than those in the control group(all P<0.05).The duration of ICU stay and hospitalization in the experimental group were shorter than those in the control group,and the frequency of airway nursing intervention,intubation rate,and complication rate in the experimental group were lower than those in the control group(all P<0.05).Conclusion In the clinical treatment of acute respiratory failure with interstitial pneumonia,both HFNC and NIPPV can achieve relatively significant therapeutic effects,and HFNC can more significantly improve the blood gas analysis status of patients,with better treatment safety and prognosis of patients.