经鼻高流量氧疗与传统经鼻导管吸氧治疗成年支气管哮喘急性发作并Ⅰ型呼吸衰竭的疗效对比

Comparison of the Efficacy of High-flow Nasal Cannula and Traditional Transnasal Catheter Oxygen Inhalation on Adult Acute Attack of Bronchial Asthma with Type Ⅰ Respiratory Failure

背景支气管哮喘(BA)是呼吸科常见病,BA急性发作并呼吸衰竭患者病情危重,而良好的呼吸支持在患者救治中可发挥重要作用。目的比较经鼻高流量氧疗(HFNC)与传统经鼻导管吸氧治疗成年BA急性发作并Ⅰ型呼吸衰竭的疗效。方法选取2017年12月—2018年12月在河北省胸科医院呼吸科住院的BA急性发作并Ⅰ型呼吸衰竭患者160例为研究对象。采用随机数字表法将患者分为对照组和观察组,各80例。对照组患者在常规治疗基础上进行传统经鼻导管吸氧,观察组患者在常规治疗基础上进行HFNC。比较两组临床疗效,治疗前和治疗1 h后心电监护指标[包括呼吸频率(RR)、心率(HR)、血氧饱和度(SpO2)]、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)],住院时间、住院费用、插管率、不良事件发生情况。结果观察组临床疗效优于对照组(P<0.05)。观察组治疗后RR、HR低于对照组,SpO2高于对照组(P<0.05)。对照组、观察组治疗后RR、HR分别低于本组治疗前,SpO2分别高于本组治疗前(P<0.05)。观察组治疗后pH值、PaO2高于对照组(P<0.05)。对照组、观察组治疗后pH值、PaO2分别高于本组治疗前(P<0.05)。观察组住院时间短于对照组,住院费用、插管率低于对照组(P<0.05)。观察组不良事件发生率低于对照组(P<0.05)。结论与传统经鼻导管吸氧相比,HFNC可以更好地改善成年BA急性发作并Ⅰ型呼吸衰竭患者的缺氧状态,缩短住院时间,降低住院费用及插管率,且安全性好,值得临床推广应用。

Background Bronchial asthma(BA)is a common disease in the Department of Respiration,and patients with acute attack of BA and respiratory failure are in critical condition,thus good respiratory support plays an important role in the treatment of patients.Objective To compare the efficacy of high-flow nasal cannula(HFNC)and traditional transnasal catheter oxygen inhalation on adult acute attack of BA with typeⅠrespiratory failure.Methods From December 2017 to December 2018,160 patients with acute attack of BA and typeⅠrespiratory failure who were hospitalized in Department of Respiration of Hebei Chest Hospital were enrolled as the research subjects,and they were divided into control group and observation group according to random number table method,with 80 cases in each group.Patients in control group received traditional transnasal catheter oxygen therapy on the basis of conventional treatment,and patients in observation group received HFNC on the basis of conventional treatment.The clinical curative effect,electrocardiogram monitoring indexes〔respiratory rate(RR),heart rate(HR),blood oxygen saturation(SpO2)〕and blood gas analysis indicators〔pH value,partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2)〕before treatment and 1 h after treatment,hospitalization time,hospitalization cost,intubation rate and occurrence of adverse reactions were compared between the two groups.Results The clinical curative effect in observation group was better than that in control group(P<0.05).After treatment,RR and HR in observation group were lower than those in control group,while SpO2 was higher than that in control group(P<0.05).RR and HR after treatment in control group and observation group were lower than those before treatment,while SpO2 was higher than that before treatment,respectively(P<0.05).The pH value and PaO2 in observation group after treatment were higher than those in control group(P<0.05).The pH value and PaO2 in control group and observation group after treatment were higher than those before treatment,respectively(P<0.05).The hospitalization time in observation group was shorter than that in control group,and the hospitalization cost and intubation rate were lower than those in control group(P<0.05).The incidence rates of adverse events in observation group were lower than those in control group(P<0.05).Conclusion Compared with traditional transnasal catheter oxygen inhalation,HFNC can better improve the hypoxic state of adult acute attack of BA patients with typeⅠrespiratory failure,shorten the hospitalization time,reduce the hospitalization cost and intubation rate,and has good safety,which is worthy of clinical application.