心衰患者应用经鼻高流量氧疗与无创通气两种呼吸支持的临床效果分析

CLINICAL EFFECTS OF TRANSNASAL HYPERFLOW OXYGEN THERAPY AND NON-INVASIVE VENTILATION IN PATIENTS WITH HEART FAILURE

目的探讨经鼻高流量氧疗与无创通气两种呼吸支持方法对急性期、稳定期左心衰竭患者的临床效果。方法回顾性分析2014年11月—2018年11月该院收治的急性期、稳定期心衰患者各100例,二组患者呼吸支持治疗前测定生命体征指标血氧分压(PaO2)、血二氧化碳分压(PaCO2)、静脉血氧饱和度(SpO2)以及氧合指数(PaO2/FiO2),以及治疗前心率(HR)、呼吸频率(RR),并根据症状表现,给予不同呼吸支持方式治疗,根据治疗方式分为急性经鼻高流量氧疗(HFNC)组与急性无创通气组,稳定HFNC组与稳定无创通气组,统计4组患者入院症状分布情况、治疗前后生命体征指标、并发症发病率、住院时间以及气管插管率,分析不同类型心衰患者在不同呼吸支持方式下的具体疗效与表现。结果急性组患者HR、RR、PaCO2水平明显高于稳定组,PaO2、SpO2、PaO2/FiO2水平明显低于稳定组(P<0.05),症状表现中除咳痰(或咯血)无差异外(P>0.05),呼吸困难、咳嗽、乏力以及头晕等,急性组临床症状严重患者较稳定组明显增多(P<0.05)。治疗24h后与治疗前比较急性无创通气组与稳定无创通气组患者各项指标与治疗前比较均有明显改善(均P<0.05),急性HFNC组PaO2、SpO2较治疗前明显改善(P<0.05),稳定HFNC组HR、RR较治疗前明显改善(P<0.05)。结论 HFNC在稳定期左心衰患者的治疗中具备可行性,而急性期左心衰患者的治疗总体而言仍然是无创通气更为有效。

Objective To investigate the clinical effect of transnasal high flow oxygen therapy and non-invasive ventilation on patients with acute and stable left heart failure.Methods A retrospective analysis of one hundred patients with acute and stable heart failure from November 2014 to November 2018.The vital signs blood oxygen partial pressure(PaO2),blood carbon dioxide partial pressure(PaCO2),venous oxygen saturation(SpO2) and oxygenation index(PaO2/FiO2),pre-treatment heart rate(HR),respiratory rate(RR) and symptom manifestations,treatment with different respiratory support methods.The treatment was divided into acute I group and acute II group,stable I group and stable II group.The distribution of admission symptoms,vital signs before and after treatment,the incidence of complications,hospital stay and tracheal intubation rate were analyzed.Results The HR、RR、PaCO2 level of acute group was significantly higher than that of stable group,and the PaO2、SpO2、PaO2/FiO2 level was significantly lower than that of stable group(P<0.05).There was no difference between dyspnea,cough,fatigue,dizziness(P>0.05).The acute group had more severe clinical symptoms than the stable group(P<0.05).The indexes of acute II group and stable II group improved significantly after 24 h compared with before treatment,and the PaO2、SpO2 of acute I group was significantly improved(P<0.05).The HR、RR of stable I group was significantly improved(P<0.05).Conclusion HFNC is feasible in the treatment of patients with stable left heart failure and for patients with acute left heart failure,treatment with non-invasive ventilation remains generally more effective.