NIPPV与经鼻高流量湿化氧疗治疗急性创伤性颈髓损伤伴呼吸衰竭疗效对比研究

Comparison of clinical effects of NIPPV and humidified high flow nasal cannula oxygen therapy in patients with acute traumatic cervical spinal cord injury complicated with respiratory failure

目的对比无创正压通气(NIPPV)与经鼻高流量湿化氧疗(HFNC)治疗急性创伤性颈髓损伤伴呼吸衰竭(RF)患者的疗效。方法选取河南大学第一附属医院收治的60例急性创伤性颈髓损伤伴RF患者作为研究对象,随机分成HFNC组(给予HFNC)和NIPPV组(给予NIPPV)各30例。观察治疗前及治疗5 d后两组患者血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))]、呼吸力学指标[气道阻力(RAW)、气道峰压(PIP)、呼吸做功(WOB)]和肺功能指标[死腔容量/潮气量(Vd/Vt)、肺动态顺应性(Cdyn)]及病情[急性生理学与慢性健康状况评分系统(APACHEⅡ)]变化,比较治疗1个月内两组患者气管插管率和治疗情况差异。结果治疗5 d后,两组患者PaO_(2)、PaO_(2)/FiO_(2)、Vd/Vt和Cdyn水平均较治疗前显著升高,且HFNC组PaO_(2)、PaO_(2)/FiO_(2)和Cdyn水平明显增高,Vd/Vt水平明显降低(均P<0.05)_(2)两组患者PaCO_(2)、RAW、PIP和WOB水平及APACHEⅡ评分均较治疗前显著降低,且HFNC组明显降低(均P<0.05)。治疗1个月内,两组患者气管插管率差异无统计学意义[9(30.00%)比11(36.67%),χ^(2)=0.300,P=0.584];HFNC组患者机械通气时间和ICU住院时间均明显较短(均P<0.05)。结论HFNC可明显改善急性创伤性颈髓损伤伴RF患者呼吸功能,摄氧效率明显,能有效稳定病情,利于预后,应用价值较高。

Objective To compare the efficacy of non-invasive positive pressure ventilation(NIPPV)and humidified high-flow nasal cannula oxygen therapy(HFNC)in patients with acute traumatic cervical spinal cord injury complicated with respiratory failure(RF).Methods Sixty patients with acute traumatic cervical spinal cord injury and RF admitted to our hospital were selected as the research subjects,and they were randomly divided into HFNC group(given HFNC)and NIPPV group(given NIPPV),with 30 cases in each group.The blood gas analysis indexes[partial pressure of arterial blood oxygen(PaO_(2)),partial pressure of arterial blood carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2))],respiratory mechanics indexes[airway resistance(RAW),peak airway pressure(PIP),work of breathing(WOB)]and lung function indicators[dead space volume/tidal volume(Vd/Vt),lung dynamic compliance(Cdyn)]and disease condition[Acute Physiology and Chronic Health Evaluation(APACHE II)]were observed before anf after 5 d of treatment,and the tracheal intubation rate and treatment status were compared between the two groups within 1 month of treatment.Results After 5 d of treatment,the levels of PaO_(2),PaO_(2)/FiO_(2),Vd/Vt and Cdyn in the two groups were significantly higher than those before treatment,and the levels of PaO_(2),PaO_(2)/FiO_(2)and Cdyn in HFNC group were significantly higher while the Vd/Vt level was significantly lower(all P<0.05).The levels of PaCO_(2),RAW,PIP and WOB and APACHE II score in the two groups were significantly lower than those before treatment,and the levels and score in HFNC group were significantly lower(all P<0.05).Within 1 month of treatment,there was no statistically significant difference in the tracheal intubation rate between the two groups[9(30.00%)vs 11(36.67%),χ^(2)=0.300,P=0.584].The mechanical ventilation time and ICU stay in HFNC group were significantly shorter(all P<0.05).Conclusion HFNC can significantly improve the respiratory function of patients with acute traumatic cervical spinal cord injury and RF,and it has obvious oxygen uptake efficiency,and it can effectively stabilize the disease condition and it is conducive to prognosis and has high application value.