经鼻高流量氧疗与无创正压通气治疗创伤相关性肺损伤的临床对比研究

Comparison study of clinical treatment of patients with trauma-associated acute lung injure treated by high-flow nasal cannula oxygen therapy and non-invasive positive pressure ventilation

目的比较经鼻高流量氧疗(HFNC)与无创正压通气(NIPV)在创伤相关性肺损伤的患者中的临床疗效,探讨HFNC在创伤相关性肺损伤中的临床应用价值。方法采用前瞻性随机对照研究方法,选取天津市第一中心医院重症医学科2017年3月至2020年3月收治的创伤合并急性肺损伤常规吸氧得不到改善患者作为研究对象。采用计算机随机软件将患者随机分为HFNC组和NIPV组,每组86例。对比两组患者的一般资料,观察两组患者氧疗后1、12、24、48 h的呼吸频率(RR)、动脉血二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))等指标,以及两组患者机械通气时间、28 d内气管插管率、重症监护病房(ICU)住院时间、病死率及对氧疗的舒适度等。结果两组患者性别、年龄等一般资料对比差异均无统计学意义。两组各时间点RR、PaCO_(2)均较治疗前明显下降,且HFNC组各时间点RR、PaCO_(2)均低于NIPV组〔1、12、24、48 h RR(次/min)分别为18.81±4.32比19.49±3.75、16.71±4.22比17.26±3.73、15.66±4.19比15.87±3.42、18.84±4.33比19.44±3.67,PaCO_(2)(mmHg,1 mmHg≈0.133 kPa)分别为46.40±6.88比48.06±6.79、45.80±6.94比47.25±6.86、44.90±6.76比46.23±6.68、43.85±7.02比45.23±6.77〕,但差异均无统计学意义(均P>0.05);两组患者的PaO_(2)/FiO_(2)均较治疗前明显升高,但HFNC组PaO_(2)/FiO_(2)与NIPV组比较差异无统计学意义(P>0.05)。HFNC组机械通气时间和ICU住院时间均明显低于NIPV组〔机械通气时间(d):7.86±2.17比9.38±1.79,ICU住院时间(d):13.06±1.66比14.79±2.12,均P<0.05〕,舒适度评分明显高于NIPV组(分:5.05±1.79比3.17±1.61,P<0.05);HFNC组28 d内的气管插管率及病死率均低于NIPV组〔气管插管率为29.1%(25例)比31.4%(27例),病死率为11.6%(10例)比14.0%(12例)〕,但差异均无统计学意义(均P>0.05)。结论HFNC可以提高患者氧含量,减轻呼吸困难,缩短患者ICU住院时间、机械通气时间,提高舒适度,是NIPV较好的替代治疗手段。

Objective To compare the clinical efficacy of transnasal high-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPV)in patients with trauma-related lung injury,and to explore the clinical application value of HFNC in trauma-related lung injury.Methods A prospective randomized controlled study method was used to select patients with trauma and acute lung injury in the department of critical care medicine,Tianjin First Central Hospital from March 2017 to March 2020,who were not improved by routine oxygen inhalation as the research objects.Using computer random software,patients were randomly divided into HFNC group and NIPV group,with 86 cases in each group.Compare the general data of the two groups of patients,observe the respiratory rate(RR),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2)),and other indicators of the two groups after 1,12,24,and 48 hours of oxygen therapy;the duration of mechanical ventilation,the rate of tracheal intubation within 28 days,the length of stay in the intensive care unit(ICU),the mortality and the comfort of oxygen therapy in the group.Results There was no statistically significant difference in general data such as gender and age between the two groups.The RR and PaCO_(2) at each time point in the two groups were significantly lower than those before treatment,and the RR and PaCO_(2) at each time point in the HFNC group were lower than those in the NIPV group[1,12,24,48 hours RR(times/min)were 18.81±4.32 vs.19.49±3.75,16.71±4.22 vs.17.26±3.73,15.66±4.19 vs.15.87±3.42,18.84±4.33 vs.19.44±3.67;PaCO_(2)(mmHg,1 mmHg≈0.133 kPa)were 46.40±6.88 vs.48.06±6.79,45.80±6.94 vs.47.25±6.86,44.90±6.76 vs.46.23±6.68,43.85±7.02 vs.45.23±6.77;all P>0.05].PaO_(2)/FiO_(2) of the two groups were significantly higher than those before treatment,but there was no statistically significant difference in PaO_(2)/FiO_(2) between the HFNC group and the NIPV group(P>0.05).The mechanical ventilation time and the length of ICU stay in the HFNC group were significantly lower than those in the NIPV group[Mechanical ventilation time(days):7.86±2.17 vs.9.38±1.79,the length of ICU stay(days):13.06±1.66 vs.14.79±2.12,both P<0.05];the comfort score was significantly higher than that of the NIPV group(5.05±1.79 vs.3.17±1.61,P<0.05);the tracheal intubation rate and mortality within 28 days of the HFNC group were lower than those of the NIPV group[tracheal intubation rate:29.1%(25 cases)vs.31.4%(27 cases),the mortality:11.6%(10 cases)vs.14.0%(12 cases)],but there were no statistically significant differences among these indexes(all P>0.05).Conclusions HFNC can increase the patient's oxygen content,relieve dyspnea,shorten the length of ICU stay,mechanical ventilation time,and improve comfort.It is a better alternative treatment for NIPV.