HFNC在慢性心力衰竭合并肺炎患者的疗效分析

Therapeutic Effect of Nasal High Flow Nasual Cannula Oxygen Therapy on Patients With Chronic Heart Failure Complicated With Pneumonia

目的探讨经鼻高流量氧疗(high flow nasal cannula oxygen therapy,HFNC)对慢性心力衰竭合并肺炎患者的治疗效果。方法选取90例(2016年1月—2018年12月)慢性心力衰竭合并肺炎患者,随机平分成HFNC治疗组与传统氧疗(traditional oxygen therapy,TOT)治疗组。TOT组采用常规抗心衰药物治疗+TOT;HFNC组采用常规抗心衰药物治疗+HFNC。对比两组患者入ICU 72小时内的机械通气发生率,探讨机械通气危险因素,比较两组治疗成功患者在治疗前后呼吸频率、动脉血氧分压、氧合指数、末梢血氧饱和度的改善程度。结果两组患者呼吸频率(P=0.00)、动脉血氧分压(P=0.00)、氧合指数(P=0.00)、末梢血氧饱和度(P=0.00)随时间均改善,并且HFNC组患者动脉血氧分压升高幅度优于TOT组(P=0.020);HFNC治疗成功率77.8%,TOT治疗成功率57.8%,差别有统计学意义(χ^2=4.121,P<0.05);APACHⅡ评分(OR=1.438,95%CI:1.756~10.107,P=0.001)和NT-proBNP(OR=2.610,95%CI:2.800~66.102,P=0.001)是HFNC组患者治疗失败的独立危险因素。结论HFNC能有效改善慢性心力衰竭合并肺炎患者的动脉血氧分压,降低机械通气发生率。

Objective To investigate the therapeutic effect of high flow nasal cannula oxygen therapy(HFNC)on patients with chronic heart failure complicated with pneumonia.Methods 90 patients(January 2016 to December 2018)with chronic heart failure complicated with pneumonia were randomly selected and divided into HFNC group and traditional oxygen therapy(TOT)group according to the digital table method,with 45 patients in each group.The TOT group received conventional antiheart failure drugs therapy+TOT;the HFNC group received conventional anti-heart failure drugs therapy+HFNC.The incidence of mechanical ventilation within 72 hours after ICU admission was compared between the two groups and the risk factors of mechanical ventilation were discussed.The improvement of respiratory rate,arterial oxygen partial pressure,oxygenation index and peripheral oxygen saturation of patients before and after successful treatment were compared between the two groups.Results The respiratory rate(P=0.00),arterial oxygen partial pressure(P=0.00),oxygenation index(P=0.00),and peripheral oxygen saturation(P=0.00)of patients in the two groups were improved with time.Moreover,the increase of arterial oxygen partial pressure in patients with HFNC was better than that in TOT group(P=0.020).The success rate of HFNC treatment was 77.8%and TOT treatment was 57.8%,with statistically significant difference(χ^2=4.121,P<0.05).APACHII(OR=1.438,95%CI:1.756~10.107,P=0.001)and NT-BNP(OR=2.610,95%CI:2.800~66.102,P=0.001)were independent risk factors for treatment failures of HFNC group.Conclusion HFNC can effectively improve the arterial oxygen partial pressure and reduce the incidence of mechanical ventilation in patients with chronic heart failure and pneumonia.