HFNC氧疗对重型COVID-19患者呼吸支持的观察研究

Observational study of respiratory support in severe COVID-19 patients with High flow nasal cannula(HFNC)oxygen therapy

目的本研究旨在探讨HFNC氧疗对于重型COVID-19病人呼吸功能的影响,以及寻找评估HFNC氧疗效果的指标。方法本研究回顾了20例接受HFNC氧疗的重型COVID-19患者资料,根据患者最终是否行气管插管分为HFNC成功组(n=15)和HFNC失败组(n=5)。收集患者在HFNC氧疗初期的生命体征如呼吸频率(RR)、血气指标如氧合指数(PaO2/FiO2)和二氧化碳分压(PaCO2)参数。观察成功组在HFNC氧疗期间的呼吸功能改变,比较成功组与失败组的相关呼吸参数差异。结果 HFNC氧疗12h后,成功组的呼吸频率显著减慢{24 (20~28)vs26 (25~30)次/min,P<0.05}、氧合指数(PaO2/FiO2)显著提高{184 (148~228)vs 144(136~195)mmHg,P<0.05};并且在HFNC氧疗的最初48h,氧合指数持续改善。失败组与成功组相比,呼吸频率更快{32 (25~34)vs 24 (20~28)次/min,P=0.02}、氧合指数更低{75(55~114)vs 184 (148~228)mmHg,P<0.01},但ROX指数无差别。结论 HFNC氧疗能改善重型COVID-19患者的呼吸功能。呼吸频率和氧合指数是决定重型COVID-19患者HFNC氧疗是否成功的关键指标。

Objective This study aimed at investigating the effects of HFNC oxygen therapy on respiratory function of severe COVID-19 patients and searching for evaluation indicators of HFNC.Methods This study retrospected data from 20 severe COVID-19 cases who received HFNC oxygen therapy.Patients were classified into two groups by the results whether they got intubation or not.15 cases were in HFNC success group and 5 in HFNC failure group.Patients’ respiratory rate and arterial blood-gas analysis indexes at the initial period of HFNC oxygen therapy were collected.The study observed the changing trends of respiratory parameters with time of HFNC therapy,and compared the difference in respiratory function between two groups.Results In success group,compared with those before HFNC therapy,respiratory rate was significantly lower {24(20~28)vs 26(25~30)次/min,P< 0.05}and oxygenation index(PaO2/FiO2)was significantly improved {184(148~228)vs 144(136~195)mmHg,P < 0.05}after 12 hrs.Better trend in oxygenation index was found at the initial continuous 48 hr HFNC therapy in success group.The comparisons between two groups revealed that faster respiratory rate(P=0.02)and worse oxygenation index were in failure group after 12 hr HNFC therapy.There was no statistically difference in ROX index between two groups.Conclusions HFNC oxygen therapy is beneficial for improving respiratory function of severe COVID-19 patients.Respiratory rate and oxygenation index are considered as key evaluation indicators.