重庆市20例经鼻高流量氧疗治疗重型新型冠状病毒肺炎的疗效分析

Analysis of the Efficiency of Treating 20 Critical Cases of 2019-nCoV with High-Flow Nasal Cannula Oxygen Therapy in Chongqing

为评价经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)治疗重型新型冠状病毒肺炎(novel coronavirus pneumonia,NCP)的临床疗效,对重庆市公共卫生医疗救治中心2020年1月24日-2月23日收治的20例接受HFNC治疗的重型NCP患者临床资料进行了回顾性分析.结果表明:经HFNC治疗后,7例(35%)患者症状及氧合指数(oxygenation index,用P/F表示)改善,继续HFNC治疗;13例患者(65%)经治疗后症状无改善或出现加重或恶化,改为无创通气(noninvasive ventilation,NIV)或有创机械通气(invasive mechanical ventilation,IMV).两组患者在性别、年龄、基础疾病等一般资料方面差异无统计学意义(p>0.05),但HFNC治疗失败组平均年龄高于HFNC治疗成功组(分别为63.30岁和57.76岁).对HFNC治疗进行失败风险的单因素分析发现,治疗成功及失败患者的初始呼吸频率、CD4+绝对值、P/F、治疗前ROX指数(rate-oxygenation index)、12 h ROX指数比较差异无统计学意义(p>0.05),但治疗成功者基线SaO 2、治疗后2 h ROX指数和治疗后12 h ROX指数显著升高(p<0.05).对单因素分子中p<0.05的因素及基线P/F用Cox风险比例模型进行分析发现,基线SaO 2、基线P/F和治疗后2 h、治疗后12 h的ROX指数均不是HFNC治疗失败的独立危险因素,但它们的值越低,HFNC治疗失败的风险就越大.基线P/F<200 mmHg(1 mmHg=0.133 kPa)时,HFNC治疗失败的风险高于P/F≥200 mmHg者.HFNC可用于治疗基线P/F≥200 mmHg的重型NCP患者,而基线P/F<200 mmHg或年龄≥50岁的患者,治疗失败的风险较大.

Objective:To evaluate the efficacy of the high-flow nasal cannula oxygen therapy(HFNC)for treatment of severe new coronavirus pneumonia(NCP)patients.Methods:The clinical data of 20 cases of severe NCP patients receiving HFNC treatment in Chongqing Public Medical Treatment Center from January 24,2020 to February 23,2020 were retrospectively analyzed.Results:After treatment,the symptoms and oxygenation index(P/F)of 7 patients(35%of the total)improved,and HFNC treatment continued.The other 13 patients(65%)showed no improvement or became worse,and they were treated with noninvasive ventilation(NIV)or invasive mechanical ventilation(IMV)in stead.There was no significant difference in gender,age,basic diseases and other general information between the two groups of patients(p>0.05),but the average age of the patients of the HFNC failure group(57.76 years)was higher than that of the success group(63.3 years).Results Single-factor analysis of failure risk showed no statistically significant differences(p>0.05)between the two groups in their respiratory rate,CD4+cell count,oxygenation index,initial ROX(rate-oxygenation)index and12 hours ROX,but the patients who succeeded in treatment had higher baseline SaO 2,2 hours after treatment ROX index and 12 hours ROX index after treatment(p<0.05).The Cox risk ratio model was used to analyze factors with p<0.05 in single factor molecules and baseline P/F,and it was found that baseline SaO 2,baseline P/F and ROX index at 2 h and12 h after treatment were not independent risk factors for HFNC treatment failure,but the lower their values,the greater the risk of failure with HFNC.With a baseline P/F lower than 200 mmHg,the risk of failure was higher than that of P/F≥200 mmHg.Conclusion:HFNC can be used to treat severe NCP patients with P/F≥200 mmHg,while in patients with baseline P/F<200 mmHg or age≥50 y,the risk of treatment failure is higher.