高流量鼻腔氧疗与无创机械通气在病毒性肺炎所致呼吸衰竭患者中的疗效比较

Comparison of efficacy between high-flow nasal oxygen therapy and non-invasive mechanical ventilation in patients with respiratory failure caused by viral pneumonia

目的探讨高流量鼻腔氧疗(HFNC)与无创机械通气(NIV)在病毒性肺炎所致呼吸衰竭患者治疗中的疗效差异。方法根据发病后6小时内呼吸支持方案,将107例病毒性肺炎所致呼吸衰竭患者分为NIV组(67例)和HFNC组(40例),通过倾向性评分匹配后纳入33对匹配患者,即NIV组和HFNC组各33例。收集其一般资料、临床资料[平均动脉压、心率、脉搏血氧饱和度、急性生理与慢性健康(APACHEⅡ)评分和治疗前及治疗12 h、24 h、48 h后的呼吸频率、动脉血气分析结果(PaCO 2、PaO 2、氧合指数)]和随访28 d临床结局相关指标[气管插管发生率、死亡率、呼吸治疗相关并发症(腹胀、鼻部皮损、肺不张、排痰困难)发生率、住院时间、治疗费用、治疗舒适度评分]并进行比较。结果两组患者一般资料和临床资料在倾向性评分匹配后差异均无统计学意义(P>0.05)。两组患者治疗12 h、24 h、48 h后的呼吸频率、PaCO 2、PaO 2、氧合指数比较差异均无统计学意义(P>0.05)。HFNC组患者随访28 d后的呼吸治疗相关并发症发生率、住院时间、治疗费用均明显低于NIV组,治疗舒适度评分高于NIV组(P<0.05)。结论HFNC与NIV对病毒性肺炎所致呼吸衰竭患者呼吸功能的改善效果相当,但HFNC舒适度更高,并发症更少,能有效缩短患者的住院时间。

Objective To investigate the difference between high-flow nasal cavity oxygen therapy(HFNC)and non-invasive mechanical ventilation(NIV)in the treatment of respiratory failure caused by viral pneumonia.Methods A total of 107 cases of respiratory failure patients caused by viral pneumonia were divided into NIV group(67 cases)and HFNC group(40 cases)according to the respiratory support protocol within 6 h after onset.Thirty-three matching pairs were included after matching by propensity score,and 33 cases in each groups.The general information,clinical data[mean arterial pressure,heart rate,pulse oxygen saturation,acute physiology and chronic health evaluation(APACHEⅡ)score,the respiratory rate and results of arterial blood gas analysis(PaCO 2,PaO 2,oxygenation index)before and 12 h,24 h,48 h after treatment]and follow-up clinical outcome related index with 28 days[incidence of endotracheal intubation,mortality,incidence of respiratory treatmentrelated complications(abdominal distension,nasal skin lesions,atelectasis,difficulty in sputum excretion),length of stay,treatment cost,treatment comfort score]were collected and compared.Results There was no statistically significant difference between the general data and clinical data of the two groups after the propensity score matching(P>0.05).There were no statistically significant differences in respiratory rate,PaCO 2,PaO 2 and oxygenation index between the two groups after 12 h,24 h and 48 h of treatment(P>0.05).After 28 days of follow-up,the incidence of respiratory treatment-related complications,length of hospital stay and treatment cost in HFNC group were significantly lower than those in NIV group,and the score of treatment comfort was higher than that in NIV group(P<0.05).Conclusion HFNC has the same effect as NIV in improving respiratory function in patients with respiratory failure caused by viral pneumonia.However,HFNC has higher comfort and fewer complications,and it can effectively shorten the hospital stay.