经鼻高流量湿化氧疗和储氧面罩氧疗对特发性肺纤维化急性加重疗效的对照研究

Comparative Study on Humidified High-Flow Nasal Cannula Oxygen Therapy and Oxygen Therapy with Oxygen Storage Mask in Treatment of Acute Exacerbation of Idiopathic Pulmonary Fibrosis

目的:对比分析经鼻高流量湿化氧疗与储氧面罩氧疗治疗特发性肺纤维化(IPF)急性加重的疗效及安全性。方法:根据随机数字表法将我院2016年3月—2018年4月收治的IPF急性加重患者80例分为研究组与对照组,各40例,全部患者入院后均接受常规治疗,在此基础上给予对照组储氧面罩氧疗,给予研究组经鼻高流量湿化氧疗,对比两组住院治疗时间,住院治疗期间不良反应发生情况、治疗中途转为气管插管+机械通气率及死亡率;分别于入院时、入院2h时、入院24h时、出院时,检测并对比两组患者动脉血气[酸碱度(pH)、氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(PO2/SiO2)]、肺功能[肺总量(TLC)、一氧化碳弥散量(DLco)]。结果:治疗各时点,两组pH值比较,差异无统计学意义(P>0.05);研究组PaO2、PO2/SiO2均较对照组升高,PaCO2较对照组降低,差异有统计学意义(P<0.05);治疗各时点,研究组TLC、DLco水平均较对照组升高,差异有统计学意义(P<0.05);研究组平均住院时间短于对照组,气管插管+机械通气率、不良反应发生率、死亡率均低于对照组,差异有统计学意义(P<0.05)。结论:IPF急性加重患者接受经鼻高流量湿化氧疗治疗效果较储氧面罩氧疗好,更利于改善患者动脉血气,提高其肺功能,且不良反应少,安全性好。

Objective:To compare the efficacy and safety of humidified high-flow nasal cannula oxygen therapy and oxygen therapy with oxygen storage mask in treatment of acute exacerbation of idiopathic pulmonary fibrosis(IPF).Methods:80 patients with acute exacerbation of IPF admitted in the hospital from March 2016 to April 2018 were divided into research group and control group by random number table,with 40 cases each group.All the patients received routine treatment after admission,and on this basis,control group was given oxygen therapy with oxygen storage mask,while research group was given humidified high-flow nasal cannula oxygen therapy.The hospital stays,adverse reactions during hospitalization,conversion rate of tracheal intubation+mechanical ventilation during treatment,death rate were compared between the two groups;on admission,after admission for 2 hours,after admission for 24 hours and on discharge,the arterial blood gas[power of hydrogen(pH),oxygen partial pressure(PaO2),partial pressure of carbon dioxide(PaCO2),oxygenation index(PO2/SiO2)],pulmonary function[total lung capacity(TLC),carbon monoxide diffusing capacity(DLco)]were compared between the two groups.Results:There was no statistical difference in the pH value between the two groups at each time of treatment(P>0.05);The PaO2 and PO2/SiO2 in research group were higher than those in control group,while the PaCO2 in research group was lower than that in control group(P<0.05);at each time of treatment,the levels of TLC and DLco in research group were higher than those in control group(P<0.05);the average hospital stays in research group were shorter than those in control group,the rate of tracheal intubation+mechanical ventilation incidence of adverse reactions and death rate in research group were lower than those in control group(P<0.05).Conclusion:Humidified high-flow nasal cannula oxygen therapy in treatment of patients with acute exacerbation of IPF is more effective than oxygen therapy with oxygen storage mask,stabilize vital signs during treatment and improve dyspnea,which has less adverse reactions and better safety.