HFNC在特发性肺纤维化并呼吸衰竭中的疗效及安全性研究

Efficacy and safety study of HFNC in idiopathic pulmonary fibrosis with respiratory failure

目的探讨经鼻高流量氧疗(HFNC)在特发性肺纤维化(IPF)并呼吸衰竭中的疗效及安全性。方法选择2019年5月~2020年4月收治的90例IPF合并呼吸衰竭者,按随机数字表法分为A组(鼻导管吸氧),B组[无创正压通气(NPPV)],C组(HFNC),每组各30例。比较三组动脉血气[包括血二氧化碳分压(PaCO2)、氧分压(PaO2)、血氧饱和度(SpO2)以及氢离子浓度指数(pH)]、6分钟步行试验(6MWT)距离、生命体征(包括心率以及呼吸频率)以及不良反应(鼻干、鼻黏膜出血、胃肠胀气发生率以及口腔干燥程度)。结果三组治疗前后的PaCO2、pH水平比较,差异无统计学意义(P>0.05);三组治疗1、3及7 d后的PaO2、SpO2水平高于治疗前,差异有统计学意义(P<0.05);B、C组治疗1、3及7 d后的PaO2、SpO2水平高于A组,差异有统计学意义(P<0.05);B、C组治疗1、3及7 d后的PaO2、SpO2指标比较,差异无统计学意义(P>0.05);三组治疗7 d后的6MWT距离长于治疗前,心率以及呼吸频率低于治疗前,且B、C组的6MWT距离长于A组,心率以及呼吸频率低于A组,差异有统计学意义(P<0.05);B、C组治疗7 d后的6MWT距离以及生命体征指标比较,差异无统计学意义(P>0.05);C组鼻干、鼻黏膜出血、胃肠胀气发生率低于A组和B组,差异有统计学意义(P<0.05);三组口腔干燥程度比较,C组轻于A组和B组,差异有统计学意义(P<0.05)。结论HFNC应用于IPF并呼吸衰竭的效果显著,可调节患者动脉血气,稳定其生命体征,减少不良反应,同时缓解患者口腔干燥程度。

Objective To investigate the efficacy and safety of high-flow nasal cannula oxygen therapy(HFNC)in idiopathic pulmonary fibrosis(IPF)with respiratory failure.Methods A total of 90 patients with IPF and respiratory failure who were admitted in the hospital from May 2019 to April 2020 were selected,and they were divided into group A(nasal catheter oxygen uptake),group B[non-invasive positive pressure ventilation(NPPV)]and group C(HFNC)according to random number table method,with 30 cases in each group.The arterial blood gas(partial pressure of carbon dioxide[PaCO2],partial pressure of oxygen[PaO2],oxygen saturation[SpO2],power of hydrogen[pH]),6-minute walking test(6MWT)distance,vital signs(heart rate and respiratory rate)and adverse reactions(incidence of nasal cavity dryness,nasal mucosal hemorrhage,flatulence,degree of xerostomia)were compared among the three groups.Results There were no statistically significant differences in the levels of PaCO2 and pH among the three groups before and after treatment(P>0.05);the levels of PaO2 and SpO2 in the three groups after treatment for 1,3 and 7 d were higher than those before treatment,the differences were statistically significant(P<0.05);the levels of PaO2 and SpO2 in group B and group C were higher than those in group A after treatment for 1,3 and 7 d,the differences were statistically significant(P<0.05);there were no statistically significant differences in the levels of PaO2 and SpO2 between group B and group C after treatment for 1,3 and 7 d(P>0.05);the 6MWT distance of the three groups after treatment for 7 d was longer than that before treatment,the heart rate and respiratory rate were lower than those before treatment,the 6MWT distance of group B and group C was longer than those of group A,and the heart rate and respiratory rate of group B and group C were lower than those of group A,the differences were statistically significant(P<0.05);there was no statistically significant difference in the 6MWT distance and vital signs between B group and C group after treatment for 7 d(P>0.05);the incidence rates of nasal dryness,nasal mucosal bleeding,and flatulence in group C was lower than that of group A and group B,and the differences were statistically significant(P<0.05);the degree of dry mouth in the three groups was compared,group C was lighter than group A and group B,the difference was statistically significant(P<0.05).Conclusion HFNC in IPF with respiratory failure has significant effect,it can regulate arterial blood gas,stabilize vital signs,reduce adverse reactions,and relieve the degree of xerostomia of the patients.