经鼻高流量氧疗与常规氧疗辅助治疗急性缺血性脑卒中并Ⅰ型呼吸衰竭患者临床疗效的对比研究

Therapeutic Efficacy of HFNC and Conventional Oxygen Therapy in the Adjuvant Therapy of Acute Ischemic Stroke Patients Complicated with TypeⅠRespiratory Failure:a Comparative Study

背景经鼻高流量氧疗(HFNC)是一种新型无创氧疗方式,能提供恒温、恒湿和高流量的气流,对Ⅰ型呼吸衰竭具有良好的治疗效果,但其在急性缺血性脑卒中(AIS)并Ⅰ型呼吸衰竭患者中的应用效果尚不明确。目的比较HFNC与常规氧疗辅助治疗AIS并Ⅰ型呼吸衰竭患者的临床疗效。方法选取2017年8月—2019年3月南京大学医学院附属鼓楼医院急诊病房和急诊重症监护室(EICU)收治的AIS并Ⅰ型呼吸衰竭患者98例,采用随机数字表法分为常规氧疗组(n=48)和HFNC组(n=50)。常规氧疗组患者经普通氧气湿化装置行经鼻/面罩吸氧,HFNC组采用费雪派克呼吸湿化治疗仪行HFNC。比较两组患者氧疗前及氧疗后2、12、24 h呼吸频率(RR)、心率(HR)及血气分析指标[包括pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血乳酸(Lac)及氧合指数],氧疗前及氧疗24 h痰液黏稠分度,EICU住院时间、3 d内气管插管率及90 d内病死率。结果时间与方法在RR、pH值、Lac、氧合指数上无交互作用(P>0.05);时间与方法在HR、PaO2、PaCO2上存在交互作用(P<0.05)。时间在RR、HR、pH值、PaO2、PaCO2、Lac、氧合指数上主效应显著(P<0.05)。方法在RR、HR、PaO2、PaCO2上主效应显著(P<0.05);方法在pH值、Lac、氧合指数上主效应不显著(P>0.05)。氧疗2、12、24 h,HFNC组患者RR和HR低于常规氧疗组,PaO2和氧合指数高于常规氧疗组(P<0.05)。氧疗24 h HFNC组患者痰液黏稠分度优于常规氧疗组(P<0.05)。HFNC组患者EICU住院时间短于常规氧疗组,3 d内气管插管率低于常规氧疗组(P<0.05)。结论与常规氧疗相比,采用HFNC纠正AIS并Ⅰ型呼吸衰竭患者缺氧效果更优,可减轻患者气道干燥程度,缩短EICU住院时间,并降低3 d内气管插管率。

Background High-flow nasal cannula(HFNC)is a new type of non-invasive oxygen therapy,which can provide constant temperature,humidity and high flow of air,it has a good therapeutic effect on treating typeⅠrespiratory failure,but its application effect on patients with acute ischemic stroke(AIS)and typeⅠrespiratory failure is unclear.Objective To compare the therapeutic effect of HFNC and conventional oxygen therapy in the adjuvant trerapy of AIS patients complicated with typeⅠrespiratory failure.Methods From August 2017 to March 2019,a total of 98 AIS patients complicated with typeⅠrespiratory failure in the Emergency Ward and Emergency Intensive Care Unit(EICU)of the Affiliated Hosptial of Nanjing University Medical School Nanjing Drum Tower Hospital were selected,and they were randomly divided into conventional oxygen therapy group(n=48)and HFNC group(n=50).The patients in the conventional oxygen therapy group were treated with nasal/mask oxygen inhalation by ordinary oxygen humidification device,and the patients in the HFNC group were treated with HFNC by Fisher Parker respiratory humidification treatment instrument.Respiratory rate(RR),heart rate(HR)and blood gas analysis indexes〔including pH value,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),blood lactic acid(Lac)and oxygenation index〕were compared between the two groups before oxygen therapy and 2,12 and 24 hours after oxygen therapy,the classification of sputum viscosity,hospitalization time in EICU,endotracheal intubation rate within 3 days and mortality within 90 days were analyzed.Results There was no statistically significant interaction in RR,pH value,Lac and oxygenation index between time and method,respectively(P>0.05).There was statistically significant interaction in HR,PaO2 and PaCO2 between time and method,respectively(P<0.05).Main effects of time was statistically significant in RR,HR,pH value,PaO2,PaCO2,Lac and oxygenation index(P<0.05).Main effects of method was statistically significant in RR,HR,PaO2 and PaCO2(P<0.05);main effects of method was no statistically significant in pH value,Lac and oxygenation index(P>0.05).2,12 and 24 hours after oxygen therapy,RR and HR of HFNC group were lower than those of conventional oxygen therapy group,PaO2 and oxygenation index were higher than those of conventional oxygen therapy group(P<0.05).24 hours after oxygen therapy,the classification of sputum viscosity of HFNC group was better than that of conventional oxygen therapy group(P<0.05).The hospitalization time in EICU of HFNC group was shorter than that of conventional oxygen therapy group,and the intubation rate within 3 days was lower than that of conventional oxygen therapy group(P<0.05).Conclusion Compared with conventional oxygen therapy,HFNC is more effective in correcting hypoxia of AIS patients with typeⅠrespiratory failure,and can reduce the degree of airway dryness,shorten the hospitalization time in EICU,reduce the endotracheal intubation rate within 3 days.