经鼻导管高流量加温湿化氧疗在重症顽固性肺炎中的疗效分析

Efficacy analysis of nasal cannula high-flow warming and humidification oxygen therapy in severe refractory pneumonia

目的探讨经鼻导管高流量加温湿化氧疗在重症顽固性肺炎中的治疗效果。方法收集2017年12月—2019年10月期间在衡水市第二人民医院就诊的110例重症顽固性肺炎患者的临床资料并进行回顾性分析,将患者随机分为两组,其中常规运用呼吸机面罩吸氧法为对照组,采用经鼻导管高流量加温湿化氧疗(HFNC)为观察组。对比两组患者氧疗前及治疗后血氧分压(PaO2)、二氧化碳分压(PaCO2)、呼吸频率(RR)、氧合指数(PaO2/FiO2)变化,观察两组患者呼吸困难度(Borg)评分、呼吸质量(SGRQ)评分,评估两组患者治疗总有效率,并比较两组患者治疗后住院时间、ICU滞留时间、自主呼吸天数及再插管的发生率。结果两组患者治疗后Borg评分、SGRQ评分均得到显著改善(P<0.05),且观察组患者治疗后Borg评分、SGRQ评分与对照组相比差异具有统计学意义(P<0.05);两组患者治疗后血气分析PaO2、PaCO2、RR及PaO2/FiO2与治疗前相比差异具有统计学意义,且观察组治疗后的PaO2、PaCO2、RR及PaO2/FiO2指数显著优于对照组(P<0.05);HFNC治疗后观察组患者ICU滞留时间短于对照组,自主呼吸天数长于对照组(P<0.05),两组患者住院时间对比差异无统计学意义(P>0.05),再插管发生率组间对比差异具有统计学意义(P<0.05)。结论经鼻导管高流量加温湿化疗法不仅可有效改善患者缺氧状态,提高自主呼吸时间,同时可降低患者再插管的风险。

Objective To analyze the therapeutic effect of transnasal catheter high flow heating and humidifying oxygen therapy in severe intractable pneumonia. Methods The clinical data of 110 patients with severe refractory pneumonia who were treated in Hengshui Second People’s Hospital from December 2017 to October 2019 were retrospectively analyzed. The patients were divided into two groups randomly. The control group was treated with ventilator mask oxygen inhalation, while the observation group was treated with nasal catheter high flow heating and humidifying oxygen therapy(HFNC). The changes of partial pressure of oxygen(PaO2), partial pressure of carbon dioxide(PaCO2),respiratory rate(RR) and oxygenation index(PaO2/FiO2) were compared between the two groups before and after oxygen therapy. The Borg score of respiratory difficulty and SGRQ score of respiratory quality were observed in the two groups. The total effective rate of the two groups was evaluated. The hospitalization time, ICU retention time, spontaneous breathing days and the incidence of re-intubation were compared between the two groups. Results The Borg score and SGRQ score of the two groups were significantly improved after treatment, and the Borg score and SGRQ score of the observation group were significantly higher than those of the control group(P<0.05). After the treatment,the indexes of PaO2, PaCO2, RR and PaO2/FiO2 in the blood gas analysis of the two groups were significantly different from those before the treatment, and the indexes of PaO2, PaCO2, RR and PaO2/FiO2 in the observation group were significantly better than those in the control group(P<0.05). The total effective rate in the observation group was significantly higher than that in the control group. After HFNC treatment, the ICU retention time and spontaneous breathing time in the observation group were significantly better than those in the control group(P<0.05). There was no significant difference in hospital stay between the two groups, and there was significant difference in the incidence of re-intubation between the two groups(P<0.05). Conclusion Transnasal catheter high flow heating and humidification therapy can not only effectively improve the hypoxia state of the patients, increase the time of spontaneous breathing, but also reduce the risk of re-intubation, which has a clinical effect on promoting the prognosis of patients.