经鼻高流量吸氧与无创辅助通气治疗非肺源性ARDS效果的临床研究

Effect of high-flow nasal cannula oxygen and noninvasive positive pressure ventilation in the treatment of non-pulmonary ARDS

目的对比经鼻高流量吸氧(HFO)与无创辅助通气(NPPV)治疗非肺源性急性呼吸窘迫综合征(ARDS)效果。方法选取2019年8月—2020年8月重庆市第五人民医院重症医学科(ICU)收治的非肺源性ARDS患者50例,应用随机数字表法将患者分为HFO组(n=25)和NPPV组(n=25),常规治疗基础上分别采取HFO和NPPV治疗。比较两组患者氧合指标、住院情况及院内获得性肺炎发生情况。结果与治疗前比较,两组患者动脉血氧分压(PaO_(2))、氧合指数(OI)均在治疗后15 min明显升高(P<0.05),但治疗后两组患者氧合指标水平比较,差异无统计学意义(P>0.05);与NPPV组比较,HFO组患者辅助通气治疗时间短,ICU住院总费用少,差异具有统计学意义(P<0.05);HFO组患者院内获得性肺炎发生率显著低于NPPV组(P<0.05)。结论两种方法均能改善非肺源性ARDS患者氧合水平,但相较于NPPV,HFO有利于避免气管插管机械通气,并减少院内获得性肺炎的发生。

Objective To investigate effect of high-flow nasal cannula oxygen(HFO)and noninvasive positive pressure ventilation(NPPV)in the treatment of non-pulmonary acute respiratory distress syndrome(ARDS).Methods Fifty patients with non-pulmonary ARDS in intensive care unit(ICU)of the Fifth People's Hospital of Chongqing from August 2019 to August 2020 were enrolled,and divided into two groups by random number table methods,each with 25 cases.Both groups received basic treatment,based on this,HFO and NPPV were given to HFO group and NPPV group,respectively.Oxygenation indexes,hospitalization related indexes and hospital-acquired pneumonia rate were compared between two groups.Results There was a significant increase in arterial partial pressure of oxygen(PaO_(2))and oxygenation index(OI)at 15 min after treatment(P<0.05),while above indexes showed no significant difference between HFO group and NPPV group(P<0.05).Compared with NPPV group,HFO group had shorter adjuvant ventilation treatment time and lower total ICU costs,with statistical difference(P<0.05).The incidence of hospital-acquired pneumonia in HFO group was significantly lower than that in NPPV group(P<0.05).Conclusion Both HFO and NPPV can improve the oxygenation level of patients with non-pulmonary ARDS,but HFO has no mechanical ventilation of tracheal intubation,thereby reducing the occurrence of hospital-acquired pneumonia.