HFNC与BiPAP在急性左心衰竭患者有创机械通气拔管后的应用对比

Comparison of application of HFNC and BiPAP in patients with acute left heart failure after extubation of invasive mechanical ventilation

目的:对比分析经鼻高流量湿化氧疗(HFNC)与双水平无创正压通气(BiPAP)在急性左心衰竭患者有创机械通气拔管后的疗效。方法:回顾性分析66例急性左心衰竭患者在机械通气拔管后发生急性呼吸衰竭的临床资料,按照治疗方法分为HFNC组(n=38)和BiPAP组(n=28)。比较两组患者治疗前、治疗2 h后的血压[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)]、血气分析[动脉氢离子浓度(pH)、动脉氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、脉搏血氧饱和度(SpO_(2))],统计两组患者治疗前、治疗7 h后的心功能[B型脑钠肽(BNP)、左室射血分数(LVEF)、心率(HR)、呼吸频率(RR)]变化,记录其围治疗期指标[48 h内再次气管插管率、呼吸机相关性肺炎(VAP)发生率、28 d病死率、ICU停留时间]。结果:治疗2 h后,两组患者SBP、DBP、MAP、PaCO_(2)下降(P<0.05),而PaO_(2)、SpO_(2)上升(P<0.05),且HFNC组上述指标变化幅度高于BiPAP组(P<0.05),pH值与治疗前比较差异无统计学意义(P>0.05);治疗7 h后,两组患者HR、RR、BNP均下降(P<0.05),LVEF上升,且除LVEF外,HFNC组上述指标变化幅度高于BiPAP组(P<0.05);HFNC组患者ICU停留时间低于BiPAP组(P<0.05),其他围治疗期指标(48 h内再次气管插管率、VAP发生率、28 d病死率)比较,差异无统计学意义(P>0.05)。结论:HFNC在急性左心衰竭患者有创机械通气拔管后治疗效果优于HFNC,值得推广。

Objective:To observe the efficacy comparison of humidified high flow nasal cannula(HFNC)and bi-level non-invasive positive airway pressure ventilation(BiPAP)in patients with acute left heart failure after extubation of invasive mechanical ventilation.Methods:The clinical data of 66 patients with acute left heart failure who developed acute respiratory failure after extubation of invasive mechanical ventilation were retrospectively analyzed.According to the treatment methods,the patients were divided into HFNC group(n=38)and BiPAP group(n=28).The blood pressure indexes[systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)]and blood gas analysis indexes[pH value,arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),saturation of pulse oxygen(SpO_(2))]were compared between the two groups before treatment and after 2 h of treatment.The cardiac function indicators[B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),heart rate(HR),respiratory rate(RR)]of the two groups were statistically analyzed before treatment and after 7 h of treatment.The peri-treatment indicators(tracheal re-intubation rate within 48 h,incidence rate of ventilator-associated pneumonia(VAP),28 d mortality rate,ICU stay)were recorded.Results:After 2 h of treatment,the SBP,DBP,MAP and PaCO_(2) in the two groups were decreased significantly(P<0.05),while the PaO_(2) and SpO_(2) were increased significantly(P<0.05),and the changes of the above indicators in HFNC group were significantly higher than those in BiPAP group(P<0.05),and there was no statistically significant difference in PH value compared with that before treatment(P>0.05).After 7 h of treatment,the HR,RR and BNP in the two groups were significantly reduced(P<0.05)while the LVEF was enhanced significantly,and the changes of above indicators except for LVEF in HFNC group were significantly higher than those in BiPAP group(P<0.05).ICU stay in HFNC group was significantly shorter than that in BiPAP group(P<0.05),there were no statistically significant differences in the other peri-treatment indicators(tracheal re-intubation rate within 48 h,incidence rate of VAP,28 d mortality rate)between the two groups(P>0.05).Conclusion:HFNC has better treatment effects than HFNC in patients with acute left heart failure after extubation of invasive mechanical ventilation,thus the former one is worthy of promotion.