经鼻高流量氧疗与无创机械通气治疗创伤相关肺损伤的疗效比较

High-flow nasal oxygen therapy versus non-invasive mechanical ventilation in treatment of patients with trauma-associated acute lung injury

目的比较经鼻高流量氧疗(HFNO)与无创机械通气(NIV)治疗创伤相关肺损伤的疗效。方法将43例外伤合并急性肺损伤(ALI)患者随机分为HFNO组20例与NIV组23例,比较2组治疗前(0 min)及治疗60、120 min的呼吸参数{呼吸频率(RR)、动脉血氧分压[p(O 2)]、氧合指数[p(O 2)/FiO 2]}、循环参数[心率、平均动脉压(MAP)、乳酸]。研究结束时,采用视觉模拟评分法评估患者呼吸困难感、不舒适感及口渴感。结果与0 min相比,2组通气60、120 min的RR显著降低,p(O 2)、p(O 2)/FiO 2显著升高(P<0.05),但循环参数(心率、MAP、乳酸)的差异无统计学意义(P>0.05);与60 min相比,2组通气120 min的呼吸及循环参数无显著变化(P>0.05)。2组患者通气60、120 min的RR、p(O 2)、p(O 2)/FiO 2、心率、MAP、乳酸比较,差异均无统计学意义(P>0.05)。HFNO组患者呼吸困难感、不舒适感、口渴感评分低于NIV组,差异有统计学意义(P<0.05)。结论HFNO与NIV都可以在短时间内改善创伤相关ALI患者的氧合情况,但HFNO具有更好的舒适性,可以作为NIV不耐受患者的替代治疗手段。

Objective To compare the efficacy of high-flow nasal oxygen(HFNO)therapy and non-invasive ventilation(NIV)therapy in treatment of patients with trauma-associated acute lung injury.Methods Totally 43 trauma patients with acute lung injury(ALI)were randomly divided into HFNO group(n=20)and NIV group(n=23).The respiratory parameters{respiratory rate(RR),partial pressure of arterial oxygen[p(O 2)],oxygenation index[p(O 2)/FiO 2]}and circulation parameters[heart rate,mean arterial pressure(MAP),lactate]before treatment(0 min)and after treatment(60 and 120 min)were compared.At the end of the study,the patients'dyspnea,discomfort and thirst were assessed by visual analogue score.Results Compared with indexes at 0 min,RR at 60 and 120 min decreased significantly in both groups,p(O 2),p(O 2)/FiO 2 increased significantly(P<0.05),but there were no significant differences in circulatory parameters(heart rate,MAP,lactate)(P>0.05).Compared with indexes at 60 min,there was no significant change in respiratory and circulatory parameters at 120 min between the two groups(P>0.05).There were no significant differences in RR,p(O 2),p(O 2)/FiO 2,heart rate,MAP and lactate between the two groups(P>0.05).The scores of dyspnea,discomfort and thirst in HFNO group were significantly lower than those in NIV group(P<0.05).Conclusion Both HFNO and NIV can improve oxygenation of ALI patients in a short time,but HFNO is more comfort,and it can be used as an alternative treatment for patients with NIV intolerance.