经鼻高流量鼻导管湿化氧疗联合氨溴索双途径给药对重症肺炎合并呼吸衰竭患者的疗效

Therapeutic effects of high-flow nasal cannula combined with dual-route administration of ambroxol on severe pneumonia complicated with respiratory failure

目的分析经鼻高流量鼻导管湿化氧疗(high-flow nasal cannula,HFNC)联合氨溴索双途径给药对重症肺炎合并呼吸衰竭患者动脉血气指标、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、肺表面活性蛋白D(surfactant protein D,SP-D)水平的影响。方法选取收治的重症肺炎合并呼吸衰竭患者92例,用随机数字表法分为观察组和对照组,每组46例。对照组给予氨溴索双途径给药(氨溴索肺泡灌洗和氨溴索雾化)治疗,观察组在对照组治疗的基础上联合应用HFNC。2组均连续治疗7 d。比较2组临床相关指标和临床疗效,治疗前后动脉血气指标和血清hs-CRP、SP-D水平的变化,记录治疗期间2组不良反应的发生情况。结果治疗后,观察组机械通气时间、住院时间均短于对照组,再插管率低于对照组(P<0.05)。观察组的总有效率(89.13%)高于对照组(71.74%),P<0.05。观察组动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))均高于对照组(P<0.05),动脉血二氧化碳分压(PaCO_(2))、血清hs-CRP和SP-D均低于对照组(P<0.05)。治疗期间,2组患者均未出现严重不良反应。结论重症肺炎合并呼吸衰竭患者接受HFNC联合氨溴索双途径给药治疗,可有效改善患者的动脉血气指标,减轻炎性反应,提高治疗效果,促进患者病情恢复。

Objective To analyze the therapeutic effects of high-flow nasal cannula(HFNC)combined with dual-route administration of ambroxol on arterial blood gas indexes,hypersensitive C-reactive protein(hs-CRP)and pulmonary surfactant protein D(SP-D)in patients with severe pneumonia and respiratory failure.Methods A total of 92 patients with severe pneumonia and respiratory failure were selected and divided into observation group and control group by the random number table method,with 46 cases in each group.The control group was treated with dual-route administration of ambroxol(alveolar lavage and aerosol inhalation of ambroxol),while the observation group was treated with HFNC on this basis,for 7 days.The relevant clinical indexes,clinical effect,changes in arterial blood gas indexes,serum hs-CRP and SP-D levels before and after treatment were compared between the 2 groups.The occurrence of adverse reactions in both groups during treatment was recorded.Results After treatment,the mechanical ventilation time and hospital stay of the observation group were shorter than those of the control group,and the re-intubation rate was lower than that in control group(P<0.05).The total effective rate in the observation group(89.13%)was higher than that in the control group(71.74%)(P<0.05).The arterial partial pressure of oxygen(PaO_(2))and oxygen saturation(SaO_(2))in observation group were higher than those in control group.The arterial partial pressure of arterial carbon dioxide(PaCO_(2)),serum hs-CRP and SP-D were lower than those in control group(P<0.05).No serious adverse reaction was observed in either group.Conclusion HFNC combined with dualroute administration of ambroxol can effectively improve arterial blood gas indexes,reduce inflammatory response,further improve curative effect and promote recovery of patients with severe pneumonia and respiratory failure.