经鼻高流量氧疗在合并共病的老年急性呼吸衰竭病人中的应用价值

Application of high-flow nasal insufflation in elderly patients with acute respiratory failure compicated with comorbidities

目的探索经鼻高流量氧疗(high-flow nasal insufflation,HFNI)在合并共病的老年急性呼吸衰竭病人中的治疗效果,期望为病人提供安全且更加舒适、耐受的供氧方式。方法通过对HFNI与无创通气(noninvasive ventilation,NIV)进行比较,分析其在合并共病的老年急性呼吸衰竭病人中的治疗效果、舒适度、耐受性等。结果与治疗前比较,治疗后HFNI和NIV组病人的pH和PaCO_(2)呈下降趋势;PaO_(2)、氧合指数等呈上升趋势,但差异无统计学意义。治疗后HFNI组较NIV组病人舒适度、痰液黏稠度、呼吸困难等有明显改善(P<0.05),平均住院时间减少(P<0.05)。2组治疗失败率和死亡率差异无统计学意义(P>0.05)。结论HFNI和NIV均可在合并共病的老年急性呼吸衰竭人群中应用,改善病人氧合功能,疗效相当。与NIV相比,HFNI舒适度高,不良反应少。

Objective To explore the therapeutic effect of high-flow nasal insufflation(HFNI)in the elderly patients with acute respiratory failure complicated with comorbidities.Methods By comparing with noninvasive ventilation(NIV),the therapeutic effect,comfort,and tolerance of the patients with acute respiratory failure after HFNI were analyzed.Results The levels of pH and arterial partial pressure of carbon dioxide(PaCO_(2))in the two groups showed a downward trend compared with those before treatment(P>0.05);The levels of arterial partial pressure of oxygen(PaO_(2))and oxygenation index showed an upward trend,but there were no statistical difference between the two groups(P>0.05).After treatment,the HFNI group had significant improvements in comfort,sputum viscosity and dyspnea compared with the NIV group(P<0.05),and the average hospital stay was lower than that of the NIV group(P<0.05).But the mortality and failure rate of treatment showed no statistical difference between the two groups(P>0.05).Conclusions Both HFNI and NIV can be used in the elderly patients with acute respiratory failure complicated with comorbidities to improve the oxygenation function of patients.Compared with NIV,HFNI is more comfortable and has fewer side effects.