NHF治疗急性低氧性呼吸衰竭的临床疗效分析

Clinical efficacy of NHF in treatment of acute hypoxic respiratory failure

目的观察经鼻高流量氧疗(nasal high-flow,NHF)治疗急性低氧性呼吸衰竭(acutehypoxemic respiratory failure,AHRF)的临床疗效,探究NHF治疗失败的危险因素。方法收集2014年6月-2016年9月在新疆医科大学附属肿瘤医院综合内科一病区和新疆医科大学第一附属医院呼吸内科收治接受NHF治疗的33例AHRF患者的临床资料,男性23例,女性10例,年龄15~100岁,平均年龄(59.7±21.2)岁。根据NHF治疗成功与否将患者分为成功组和失败组,比较两组患者的临床资料、实验室检查结果、NHF治疗时间、呼吸频率(respiratory rate,RR)、血气分析结果及临床转归指标。结果 NHF治疗成功率为78.8%。失败组APACHE II评分为(15.8±4.1)分,大于成功组(11.2±4.9)分,失败组RR值为(31.0±8.0)次/min,大于成功组(24.8±7.1)次/min,差异有统计学意义(P<0.05)。成功组平均动脉压为(12.1±2.0)kPa,大于失败组(10.3±1.9)kPa,差异有统计学意义(P<0.05)。与失败组比较,成功组PaO2和氧合指数差异有统计学意义(P<0.05)。失败组病死率(57.1%)大于成功组(0.0%),差异有统计学意义(P<0.05)。成功组住ICU时间为(9.2±7.9)d,短于失败组(18.2±10.2)d,差异有统计学意义(P<0.05)。Logistic回归分析显示,NHF治疗失败的危险因素为患者治疗前APACHE II评分≥12分(OR=1.252,95%CI:1.037~1.511,P<0.05)和RR≥30次/min(OR=1.139,95%CI:1.012~1.281,P<0.05)。结论 NHF是AHFR患者安全、有效并且依从性良好的呼吸支持方式,对于NHF治疗前APACHE II评分较高和RR较快的患者,如NHF治疗后氧合无明显改善,应尽早改为机械通气。

Objective To observe the nasal high flow oxygen therapy（nasal high-flow,NHF）for the treatment of acute hypoxemic respiratory failure（acutehypoxemic respiratory failure,AHRF）the clinical curative effect,to explore the risk factors for treatment failure of NHF.Methods From June 2014 to September 2016 in the First Affiliated Hospital of Xinjiang Medical University Affiliated Tumor Hospital Comprehensive medical ward and respiratory medicine from Xinjiang Medical University received NHF treatment of 33 cases of AHRF patients with clinical data,23 cases were male,10 females,aged 15 to 100years old,the average age（59.7±21.2）years old.According to the NHF treatment success were divided into success group and failure group,compared two groups of patients with clinical data,laboratory examination results,NHF treatment time,respiratory frequency（respiratory rate,RR）,the results of blood gas analysis and clinical outcome.Results The success rate of NHF was 78.8%.Failure group APACHE II score（15.8±4.1）score was greater than that of the successful group（11.2±4.9）,RR（31.0±8.0）in the failure group was greater than that in the successful group（24.8±7.1）/min,the difference was statistically significant（P〈0.05）.The mean arterial pressure（12.1±2.0）kPa of the successful group was higher than that of the failure group（10.3±1.9）kPa,the difference was statistically significan（P〈0.05）.Compared with the control group,the difference of PaO2 and oxygenation index in the successful group was statistically significant（P〈0.05）.The mortality rate of the failure group（57.1%）was higher than that of the successful group（0.0%）,the difference was statistically significant（P〈0.05）.ICU（9.2±7.9）d in the successful group was less than that in the failure group（18.2±10.2）d,the difference was statistically significant（P〈0.05）.Logistic regression analysis showed that the risk factors of failure of NHF treatment for APACHE patients before treatment II score more than 12 points（OR =1.252,95%CI：1.037-1.511,P〈0.05）and RR≥30/min（OR =1.139,95%CI：1.012-1.281,P〈0.05）.Conclusion NHF is a safe,effective and well tolerated in patients with AHFR respiratory support mode for NHF APACHE before treatment II score higher and faster RR patients,such as oxygenation after NHF treatment had no obvious improvement,should be changed into mechanical ventilation.