妊娠合并心功能不全患者经鼻高流量湿化氧疗疗效分析

Efficacy analysis of high-flow nasal cannula humidified oxygen therapy in pregnant patients with cardiac dysfunction

目的:对比经鼻高流量湿化氧疗(HFNC)与无创正压通气(NPPV)在妊娠合并心功能不全患者中的疗效,探讨HFNC在妊娠合并心功能不全支持治疗中的应用价值。方法:采用回顾性队列研究方法,纳入2017年1月至2021年12月入住重症监护病房(ICU)的妊娠合并心功能不全患者共53例,分为HFNC治疗组(35例),NPPV治疗组(18例)。比较两组患者的一般资料,治疗后的氧合指数(PaO_(2)/FiO_(2))、呼吸频率(RR)、动脉血二氧化碳分压(PaCO_(2))等相关指标,以及入院28 d内肠胀气发生率、气管插管率、SOFA评分、ICU住院时间与总住院费用等预后指标。结果:两组患者一般情况比较差异无统计学意义(P>0.05)。与NPPV组相比,HFNC组在治疗后2 d PaCO_(2)、PaO_(2)/FiO_(2)均有显著改善(P<0.05),两组RR无显著差异(P>0.05)。HFNC组SOFA评分、ICU住院时间及总住院费用明显降低(P<0.05)。两组气管插管率、肠胀气发生率比较无显著差异(P>0.05)。结论:经鼻高流量湿化氧疗可明显改善妊娠合并心功能不全患者的呼吸功能、改善患者临床结局,缩短ICU住院时间。

Objective:To compare the efficacy of high-flow nasal cannula humidified oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NPPV)and explore the application value of HFNC in the supportive treatment of pregnant patients with cardiac dysfunction.Methods:A retrospective cohort study method was used to recruit a total of 53 pregnant patients with cardiac dysfunction who were admitted to the intensive care unit(ICU)from January 2017 to December 2021.They were divided into HFNC group(35 cases)and NPPV group(18 cases).The general clinical data,oxygenation index(PaO_(2)/FiO_(2)),respiratory rate(RR),partial pressure of carbon dioxide(PaCO_(2))in arterial blood,and other related indicators after treatment,as well as the rate of endotracheal intubation and flatulence,SOFA score,ICU length of stay and total hospitalization expenses within 28 days of admission were compared between the two groups.Results:There was no significant difference in the general conditions between the two groups(P>0.05).As compared with the NPPV group,the HFNC group showed significant improvement in PaCO_(2) and PaO_(2)/FiO_(2) after 2 days of treatment(P<0.05),while there was no significant difference in the improvement of RR between the two groups.The SOFA score,ICU length of stay,and total hospitalization costs in the HFNC group were significantly lower(P<0.05).There was no significant difference in the rate of endotracheal intubation and the incidence of flatulence between the two groups(P>0.05).Conclusion:High-flow nasal cannula oxygen therapy can significantly improve the respiratory function of pregnant patients with cardiac dysfunction,improve the clinical outcome of patients and shorten the length of stay in ICU.