经鼻高流量湿化氧疗治疗急性氯气中毒的临床效果

The clinical effect of high⁃flow nasal cannula oxygen therapy on acute chlorine poisoning

目的探讨经鼻高流量湿化氧疗(High flow Nasal Cannula Oxygen Therapy,HFNC)治疗急性氯气中毒的临床疗效,为刺激性气体中毒的救治提供新的途径。方法对山东省聊城市人民医院急诊科2014-01至2020-01住院治疗的27例急性氯气中毒患者的临床资料进行回顾性分析,按照治疗方法分为常规鼻导管吸氧组(Routine Nasal Catheter Oxygen Absorption,RNC)(RNC组,n=12)和经鼻高流量湿化氧疗组(HFNC组,n=15)。RNC组患者给予常规鼻导管吸氧,HFNC组患者给予经鼻高流量吸氧,余治疗措施包括保护重要脏器功能、激素、抗炎、雾化、营养支持等相同。比较两组患者在入院时以及入院后治疗过程中氧合指数、炎症指标的水平变化;同时比较两组患者肺功能恢复正常的时间和住院的时间。结果两组患者入院时的氧合指数、白细胞计数(White Blood Count,WBC)和C反应蛋白(C Reactive Protein,CRP)的水平均无明显差异(P均>0.05)。但随着治疗时间的变化,HFNC组的氧合指数优于RNC组,两者存在组间差异(F=294.432,P<0.001)。此外,HFNC组与RNC组的炎症指标随着治疗时间的变化亦存在组间差异(WBC:F=30.517,P<0.001;CRP:F=17.536,P<0.001)。HFNC组患者肺功能恢复正常的时间和住院的时间均短于RNC组(Z=-2.099,t=2.469,P均<0.05)。结论经鼻高流量湿化氧疗能够较好的改善急性氯气中毒患者的氧合指数,减轻机体的炎症反应,促进患者肺功能的恢复,减少住院时间,有益于急性氯气中毒患者的治疗。

Objective To investigate the clinical efficacy of High-Flow Nasal Cannula oxygen therapy(HFNC)in the treatment of acute chlorine poisoning,so as to provide a new solution to irritant gas poisoning.Methods The clinical data of 27 patients with acute chlorine poisoning who were hospitalized in the Emergency Department of the Liaocheng People's Hospital of Shandong Province from January 2014 to January 2020 were retrospectively analyzed.The patients were divided into the Routine Nasal Catheter oxygen absorption group(RNC group,n=12)and the High-Flow Nasal Cannula oxygen therapy group(HFNC group,n=15).The routine nasal catheter oxygen absorption was applied to the RNC group,while high-flow nasal cannula oxygen therapy was used in the HFNC group.The other treatments,including the protection of important organs function and hormonal,anti-inflammatory,atomizing,and nutritional supports,remained the same.Oxygenation index and inflammation indices were compared between the groups at the time of admission and during the treatment.The recovery duration of pulmonary function and the patients’hospitalization time were also analyzed.Results There was no significant differences in the oxygenation index,White Blood Count(WBC)and C-reactive protein(CRP)at the time of admission(all P>0.05).However,over time of treatment,the oxygenation index of the HFNC group was significantly better than that of the RNC group(F=294.432,P<0.001).In addition,there were also group differences in inflammatory indicators as the treatment went on(WBC:F=30.517,P<0.001;CRP:F=17.536,P<0.001).Both the recovery duration of pulmonary function and hospitalization time of the HFNC group were shorter than that of the RNC group(Z=-2.099 and t=2.469,all P<0.05).Conclusion For patients with acute chlorine poisoning,the high-flow nasal cannula oxygen therapy could further improve the oxygenation index,reduce the body's inflammatory reaction,facilitate the recovery of lung functions,and shorten the hospitalization time,which is beneficial to the treatment of patients with acute chlorine poisoning.