高流量氧疗与无创通气在肺癌合并呼吸衰竭患者中的应用比较

Comparison of efficacy of high flow oxygen therapy versus noninvasive ventilation in patients with lung cancer complicated with respiratory failure

目的探讨高流量氧疗与无创通气在肺癌合并呼吸衰竭患者中的应用效果。方法选取2016年6月至2019年6月间榆林市第二医院收治的110例肺癌晚期合并呼吸衰竭的患者,采用随机数字表法分为观察组和对照组,每组55例。对照组患者在抗感染、止咳化痰、营养支持和抑制肿瘤等对症治疗基础上采用无创通气治疗,观察组患者在对症治疗的基础上采用经鼻导管高流量氧疗,比较两组患者治疗前后的呼吸循环相关指标、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、肺部感染评分(CPIS)及结局指标。结果治疗前,两组患者呼吸、心率、二氧化碳分压(Pa CO2)、氧分压(Pa O2)和氧合指数(Pa O2/Fi O2)水平比较,差异无统计学意义(P> 0.05)。治疗后,观察组患者上述指标均优于对照组,差异均有统计学意义(P <0.05)。治疗前,两组患者CPIS和APACHEⅡ评分比较,差异无统计学意义(P> 0.05)。治疗后,两组患者CPIS和APACHEⅡ评分均降低,且观察组均低于对照组,差异均有统计学意义(P <0.05)。观察组患者气管插管人数、死亡人数和视觉模拟评分(VAS)均优于对照组,差异均有统计学意义(P <0.05)。结论高流量氧疗可较好改善肺癌合并呼吸衰竭患者的呼吸循环相关指标、APACHEⅡ评分、CPIS评分及治疗结局,临床效果优于无创通气。

Objective To compare the efficacy of high flow oxygen therapy versus noninvasive ventilation in lung cancer patients with respiratory failure. Methods A total of 110 patients with advanced lung cancer complicated with respiratory failure admitted to Yulin Second hospital from June 2016 to June2019 were selected as the study subjects. They were divided into an observation group and a control group by random number table method,with 55 patients each. The observation group was given high-flow nasal cannula oxygen therapy plus symptomatic treatment and the control group was given non-invasive ventilation therapy on the basis of symptomatic treatment such as anti-infection,cough and phlegm relieving,nutrition support and tumor suppression. Respiratory related indicators,acute physiology,age and chronic health evaluation( APACHE) Ⅱ score,clinical pulmonary infection score( CPIS) score and outcome indicators were compared between the two groups before and after the treatment. Results There were no significant differences in respiratory,heart rate,Pa CO2,Pa O2,oxygenation index and Pa O2/Fi O2 levels between the two groups before the treatment( P > 0. 05),and the above indicators in were significantly better the observation group than in the control group after the treatment( all P < 0. 05). Difference in CPIS and APACHEⅡ scores was not statistically significant between two groups before the treatment( P > 0. 05). CPIS and APACHE Ⅱ scores decreased in both groups after the treatment with the observation group significantly lower than the control group( all P < 0. 05). The number of patients intubated,death toll and visual analog scale( VAS) score were significantly lower in the observation group than in the control group( all P < 0. 05).Conclusion High flow oxygen therapy can significantly improve respiratory cycle related indicators,APACHE Ⅱ score,CPIS score and the treatment outcome,with clinical effect better than noninvasive ventilation n patients with lung cancer complicated with respiratory failure.