高流量鼻导管湿化氧疗治疗肺结核并呼吸衰竭

Humidified High Flow Nasal Cannula for Treatment of Tuberculosis and Respiratory Failure

目的探讨高流量鼻导管湿化氧疗(HHFNC)对肺结核并呼吸衰竭的临床应用效果。方法分析2016年1月至2017年12月昆明市第三人民医院重症医学科住院、未达到有创机械通气指征的成人肺结核并呼吸衰竭患者60例,根据治疗方法分为高流量鼻导管湿化氧疗组(HHFNC组)、无创正压通气组(NIPPV组),每组各30例。比较2组的治疗效果,治疗前、治疗后12 h、24 h、48 h的呼吸频率(RR)、脉搏血氧氧饱和度(SpO2)、动脉血氧分压(Pa O2)、动脉学二氧化碳氧分压(Pa CO2)及氧合指数(Pa O2/Fi O2)等多项指标,以及患者的主要症状体征消失时间、住院时间和舒适性、耐受性、腹胀发生率及漏气率。结果 (1) HHFNC组和NIPPV组治疗后呼吸困难、紫绀消失时间及平均住院天数的比较差异无统计学意义(P>0.05);(2) HHFNC组较NIPPV组舒适性和耐受性更好、腹胀发生率和漏气率更低,差异有统计学意义(P<0.05);(3) 2组在改善RR方面有差别,HHFNC组治疗后12 h、24 h的RR改善更明显,差异有统计学意义(P<0.05);2组治疗后48 h的RR改善,差异无统计学意义(P>0.05)。2组治疗后各时间点的SpO2、PaO2、Pa CO2、Pa O2/Fi O2的指标比较,差异均无统计学意义(P>0.05);(4) HHFNC组治疗有效率与NIPPV组相近(90%vs 86.7%),差异无统计学意义(P>0.05)。结论 HHFNC组治疗肺结核并呼吸衰竭疗效与无创正压通气组相当,但具有更好的舒适性和耐受性,腹胀发生率和漏气率更低,在早期治疗降低RR方面具有显著优势,是一种适宜推广的无创呼吸支持技术。

Objective To explore the clinical efficacy of humidified high flow nasal cannula（HHFNC ） ontreatment of tuberculosis and respiratory failure.Methods Sixty cases of tuberculosis and respiratory failure inadults,who received treatment in intensive care unit of the Third People’ s Hospital of Kunming and did not meet theindications of invasive mechanical ventilation were analyzed,from January 2016 to December 2017.According tothe treatment method,it was divided into humidified high flow nasal cannula group （HHFNC group） and noninvasive positive respiratory pressure ventilation group （NIPV group）,30 cases in each group. We compared thetreatment effect between the two groups, before and after treatment for 12h,24h,48h respiratory rate （RR）,pulse oxygen saturation （SpO2 ）,arterial blood oxygen partial pressure （PaO2 ）,arterial oxygen partial pressurecarbon dioxide（PaCO2 ） and oxygenation index（PaO2/FiO2 ）,as well as the main symptoms and signs disaPearedin patients with time, length of hospital stay and comfort,tolerance,the incidence of abdominal distension and leak rate.Results（1） There was no statistically significant difference between HHFNC group and NIPV group inrespiratory difficulties,cyanosis disaPearance time and average length of stay in hospital（ P〉0.05） . （2）HHFNC group had better comfort and tolerance,lower incidence of abdominal distension and air leakage than NIPVgroup,and the difference was statistically significant（ P〈 0.05） . （3） There was a difference in RR improvementbetween the two groups.after treatment in HHFNC group,RR improvement at 12h and 24h was more obvious, andthe difference was statistically significant （ P〈 0.05） .After treatment,there was no significant difference in RRimprovement at 48 h between the two groups,with no statistical significance（ P〉0.05） .Comparison of SpO2,PaO2,PaCO2 and PaO2/FiO2 at each time point after treatment between the two groups showed no statisticallysignificant difference（ P〉 0.05 ） . （4 ） The therapeutic efficiency of HHFNC group was similar to that of NIPVgroup （90% to 86.7%）,and the difference was not statistically significant（ P〉0.05） .Conclusion HHFNCgroup has the same therapeutic effect on tuberculosis and respiratory failure as noninvasive positive pressureventilation group,but has better comfort and tolerance,the incidence of abdominal distension and leak rate lower, inthe early treatment to reduce the RR has significant advantages,is a kind of noninvasive respiratory suPorttechnology that is suitable for promotion.