经鼻高流量湿化氧疗在急性呼吸衰竭患者中应用效果的回顾性研究

A retrospective study of high-flow nasal cannula oxygen therapy in patients with acute respiratory failure

目的分析经鼻高流量湿化氧疗(HFNC)在急性呼吸衰竭患者中的应用效果,并探究预测HFNC治疗失败的指标。方法回顾性分析2018年1月至2020年9月因急性呼吸衰竭在湖南省人民医院急诊科应用HFNC的174例患者的临床资料。比较应用HFNC前及应用HFNC后1 h患者的生命体征、血气分析及呼吸困难评分和SpO_(2)/FiO_(2)与呼吸频率的比值,判断HFNC的应用效果。将患者48 h内呼吸支持升级为无创通气、气管插管或死亡定义为HFNC失败,分析预测HFNC失败的指标。结果HFNC失败率为24.14%(42/174),成功组应用HFNC前后心率、SpO_(2)、收缩压、舒张压和PaO_(2)比较差异有统计学意义(t值为-8.12~4.60,均P<0.05)。多因素Logistic回归分析显示,收缩压的变化值是HFNC失败的保护因素(OR=0.967,95%CI 0.949~0.985,P<0.05)。结论HFNC在急性呼吸衰竭患者中应用具有可行性和有效性,收缩压的变化值是预测HFNC失败的指标。

Objective To analyze the effect of high-flow nasal cannula(HFNC)oxygen therapy in patients with acute respiratory failure,and investigate the indicators that predict the failure of HFNC.Methods The clinical data of 174 patients with acute respiratory failure were retrospectively analyzed.The patients were treated with HFNC in the Emergency Department of Hunan Provincial People′s Hospital from January 2018 to September 2020.The vital signs,blood gas analysis,Borg score and ROX index of patients before and one hour after HFNC application were compared,and the application effect of HFNC was judged.The HFNC failure group was defined as patients with respiratory support upgraded to non-invasive ventilation,endotracheal intubation or death within 48 h,and the indicators for predicting the HFNC failure were analyzed.Results The failure rate of HFNC was 24.13%(42/174).There were significant differences in the heart rate,SpO_(2),systolic blood pressure,diastolic blood pressure and PaO_(2) of successfal group before and after the use of HFNC,t values were-8.12-4.60,all P<0.05.Multivariate Logistic regression analysis showed that the change value of systolic blood pressure was a protective factor of the failure of HFNC(OR=0.967,95%CI were 0.949-0.985,P<0.05).Conclusions The application of HFNC in patients with acute respiratory failure is feasible and effective,and the change value of systolic blood pressure is an indicator to predict the failure of HFNC.