经鼻高流量湿化氧疗治疗低氧性呼吸衰竭的疗效

Efficacy of High-flow Nasal Cannula Oxygen Therapy on Hypoxic Respiratory Failure

目的探讨经鼻高流量湿化氧疗(HFNC)治疗低氧性呼吸衰竭的临床疗效。方法选取2019年10月~2020年4月于承德市中心医院呼吸内科住院诊断为低氧性呼吸衰竭并接受HFNC治疗的53例患者为研究对象,所有患者均在临床对症支持治疗基础上加用HFNC治疗。观察患者应用HFNC治疗0、2、12、24 h的生命体征情况,包括呼吸频率、心率、经皮血氧饱和度以及临床治疗结局。结果患者0、2、12、24 h心率比较,差异有统计学意义(P<0.05);患者0、2、12、24 h呼吸频率、经皮血氧饱和度比较,差异有统计学意义(P<0.05);患者0 h与2 h、0 h与12 h、0 h与24 h呼吸频率、经皮血氧饱和度比较,差异有统计学意义(P<0.05),患者2 h与12 h、2 h与24 h、12 h与24 h呼吸频率、经皮血氧饱和度比较,差异无统计学意义(P>0.05);治疗成功46例,失败7例,成功率86.79%;治疗后2 h经皮血氧饱和度的曲线下面积为0.755,0、12、24 h的经皮血氧饱和度和0、2、12、24 h的心率及呼吸频率曲线下面积均小于0.700,HFNC治疗后2 h经皮血氧饱和度的截点值为0.935,其灵敏度和特异度分别为0.717、0.714。结论HFNC是治疗低氧性呼吸衰竭患者的有效氧疗方式。治疗过程中需密切监测生命体征并及时调整或升级氧疗方式,如应用HFNC治疗2 h的经皮血氧饱和度不能达到93.5%,则应尽早考虑调整氧疗方式。

Objective To explore the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)through the nose in the treatment of hypoxic respiratory failure.Methods From October 2019 to April 2020,53 patients who were hospitalized in the Department of Respiratory Medicine of Chengde Central Hospital and were diagnosed with hypoxic respiratory failure and received HFNC treatment were selected as the research objects.All patients were treated with HFNC on the basis of clinical symptomatic and supportive treatment.Observe the patient's vital signs at 0,2,12,and 24 h after HFNC treatment,including respiratory rate,heart rate,transcutaneous oxygen saturation,and clinical treatment outcome.Results The heart rate of patients at 0,2,12,and 24 h showed a statistically significant difference(P<0.05);Comparison of respiratory rate and transcutaneous oxygen saturation between patients at 0,2,12,24 h,the difference was statistically significant(P<0.05);There were statistically significant differences in the respiratory rate and transcutaneous oxygen saturation between patients 0 h and 2 h,0 h and 12 h,0 h and 24 h(P<0.05).There were no statistically significant differences in the respiratory rate and transcutaneous oxygen saturation of patients at 2 h and 12 h,2 h and 24 h,12 h and 24 h(P>0.05);46 cases were successfully treated and 7 cases failed,with a success rate of 86.79%;The area under the curve of transcutaneous oxygen saturation at 2 h after treatment was 0.755,and the area under the curve of transcutaneous oxygen saturation at 0,12,and 24 h and heart rate and respiratory rate at 0,2,12,and 24 h were all less than 0.700,the cut-off point of transcutaneous oxygen saturation at 2 h after HFNC treatment was 0.935,and its sensitivity and specificity were 0.717 and 0.714,respectively.Conclusion HFNC is an effective way of oxygen therapy for patients with hypoxic respiratory failure.During the treatment process,vital signs should be closely monitored and the oxygen therapy method should be adjusted or upgraded in time.If the percutaneous oxygen saturation of 2 h of HFNC treatment cannot reach 93.5%,the oxygen therapy method should be considered as soon as possible.