经鼻高流量氧疗在特发性肺纤维化急性加重患者中的应用效果

Effect of high-flow nasal cannula oxygen therapy in patients with acute exacerbation of idiopathic pulmonary fibrosis

目的观察经鼻高流量氧疗(HFNC)在特发性肺纤维化急性加重(AE-IPF)患者中的应用疗效。方法选取2019年1月至2021年1月因AE-IPF收入本院的70例患者作为研究对象,按照不同呼吸支持方式分为鼻导管吸氧(COT)组(n=22)、HFNC组(n=25)及无创通气(NPPV)组(n=23),分别在12、48 h后监测患者呼吸频率(RR)、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2)),比较3组气管插管率、住院时间、病死率。结果治疗12 h后,3组RR、PaCO_(2)比较差异无统计学意义;HFNC组PaO_(2)和PaO_(2)/FiO_(2)高于COT组和NPPV组,且NPPV组PaO_(2)/FiO_(2)高于COT组,差异有统计学意义(P<0.05)。治疗48 h后,HFNC组RR低于COT组和NPPV组,且NPPV组RR低于COT组,差异有统计学意义(P<0.05);HFNC组PaO_(2)和PaO_(2)/FiO_(2)高于COT组和NPPV组,且NPPV组PaO_(2)/FiO_(2)高于COT组,差异有统计学意义(P<0.05);3组PaCO_(2)比较差异无统计学意义。HFNC组气管插管率低于NPPV组及COT组,差异有统计学意义(P<0.05),NPPV组与COT组差异无统计学意义;3组住院时间及住院期间死亡率比较差异无统计学意义。结论HFNC治疗AE-IPF的疗效显著,能明显改善患者PaO_(2)/FiO_(2),降低插管率,患者耐受性好,操作方便,患者依从较好,值得临床推广应用。

Objective To observe the effect of high-flow nasal cannula oxygen therapy(HFNC)in patients with acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF).Methods A total of 70 inpatients admitted to our department due to acute exacerbation of IPF from January 2019 to January 2021 were selected as the research subjects,and they were divided into the COT group(n=22),the HFNC group(n=25)and the NPPV group(n=23)according to different respiratory support methods.After 12 h and 48 h,the respiratory rate(RR),oxygen partial pressure(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),artial pressure of oxygen/fraction of inspiration O_(2)(PaO_(2)/FiO_(2)),tracheal intubation rate during hospitalization,hospitalization time and in-hospital mortality were monitored.Results After 12 h of treatment,there was no significant difference in RR and PaCO_(2)amongthe three groups;PaO_(2)and PaO_(2)/FiO_(2)in the HFNC group were higher than those in the COT group and NPPV group,and PaO_(2)/FiO_(2)in the NPPV group was higher than that in the COT group,the differences were statistically significant(P<0.05).After 48 h of treatment,RR in the HFNC group was lower than that in the COT group and the NPPV group,and RR in the NPPV group was lower than that in the COT group,the differences were statistically significant(P<0.05);PaO_(2)and PaO_(2)/FiO_(2)in the HFNC group were higher than those in the COT group and the NPPV group,and PaO_(2)/FiO_(2)in the NPPV group was higher than that in the COT group,the differences were statistically significant(P<0.05);there was no significant difference in PaCO_(2)among the three groups.The tracheal intubation rate in the HFNC group was lower than that in the NPPV group and COT group,and the difference was statistically significant(P<0.05),but there was no statistical difference between NPPV group and COT group.There was no significant difference in hospitalization time and mortality among the three groups.Conclusion HFNC in the treatment of AE-IPF has significant efficacy,can significantly improve the PaO_(2)/FiO_(2)of patients,reduce the intubation rate,patient tolerance is good,easy to operate,patient compliance is good,worthy of clinical promotion and application.