经鼻高流量氧疗和无创机械通气在治疗新型冠状病毒肺炎所致急性呼吸窘迫综合征的比较研究

The comparative study of high-flow nasal cannula oxygen therapy and non-invasive ventilation in treatment of acute respiratory distress syndrome induced by severe coronavirus disease 2019

目的比较经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)与无创机械通气(non-invasive ventilation,NIV)治疗新型冠状病毒肺炎(简称新冠肺炎)所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床疗效及安全性。方法收集2020年1月25日—2020年3月10日武汉红十字会医院收治的新冠肺炎所致的ARDS患者68例的临床资料,根据治疗方法分为HFNC组36例和NIV组32例。所有患者均给予基础疾病对症治疗、抗病毒治疗、预防继发性感染等常规治疗,NIV组同时给予NIV治疗,HFNC组同时给予高流量湿化氧疗,比较两组呼吸与循环参数、舒适度与耐受性、并发症等指标。结果在治疗3天、治疗1周、治疗2周后,两组患者呼吸频率(respiratory rate,RR)低于同组治疗前,动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))、脉搏血氧饱和度(pulse oxygen saturation,SpO_(2))、氧合指数(PaO_(2)/FiO_(2))高于同组治疗前(均P<0.05),且治疗效果呈时间依赖性关系。但不同时间点HFNC组与NIV组患者RR、PaO_(2)、SpO_(2)、PaO_(2)/FiO_(2)比较,差异均无统计学意义(均P>0.05);治疗2周内,HFNC组患者舒适度、呼吸困难、耐受性评分低于NIV组(均P<0.05),而胃胀、口干等并发症的发生率低于NIV组(11.11%比37.50%,P<0.05)。两组有创机械通气率、病死率比较,差异无统计学意义(均P>0.05)。结论HFNC与NIV均能有效改善新冠肺炎所致ARDS患者呼吸与循环参数,而HFNC具有更好的舒适性与耐受性,能减少相关并发症的发生。

Objective To compare the clinical efficacy and safety of high-flow nasal cannula oxygen therapy(HFNC)and non-invasive ventilation(NIV)in treatment of acute respiratory distress syndrome(ARDS)induced by coronavirus disease 2019(COVID-19).Methods Sixty-eight patients with ARDS induced by COVID-19 in Wuhan Concorde Red Cross Hospital form January 25,2020 to March 10,2020 were included in the study.They were divided into an HFNC group(n=36)and an NIV group(n=36)according to the treatment.All patients received basic routine treatment,antiviral treatment and prevention therapy of secondary infection.The HFNC group received high-flow nasal cannula oxygen therapy,and the NIV group received NIV therapy.Then respiration and circulation parameters,comfort and tolerance,complications were compared between the two groups.Results After treatment for 3 days,1 week,and 2 weeks in all patients with COVID-19 induced ARDS,respiratory rate(RR)was lower than that before therapy,arterial partial pressure of oxygen(PaO_(2)),pulse oxygen saturation(SpO_(2)),PaO_(2)/FiO_(2) were higher than those before therapy(P<0.05),and therapeutic effect was time-dependent.But there was no significant difference of RR,PaO_(2),SpO_(2),PaO_(2)/FiO_(2) between the HFNC group and the NIV group at different time points(P>0.05).After treatment for 2 weeks,the HFNC group patients’comfort,difficulty breathing,tolerance score were lower than the NIV group(P<0.05,P<0.01),the incidence rate of gastric distension and dry mouth etc.was lower than that in the NIV group(11.11%vs.37.50%,P<0.05).There was no significant difference in rate of invasive mechanical ventilation or mortality between the two groups(P>0.05).Conclusions HFNC and NIV can improve respiratory and circulatory parameters of patients with COVID-19 induced ARDS.HFNC has better comfort and tolerance,and can reduce related complications.