经鼻高流量湿化氧疗在经皮冠状动脉介入治疗后急性心肌梗死患者中的应用价值分析

Application value of high flow nasal cannula oxygen in patients with acute myocardial infarction after percutaneous coronary intervention

目的 探讨经鼻高流量湿化氧疗 (HFNCO) 对经皮冠状动脉介入治疗 (PCI) 后急性心肌梗死 (AMI) 患者的临床效果。方法 60 例 PCI 术后 AMI 患者,采用随机数字表法分为常规组和高流量组,每组 30 例。常规组采用鼻导管 / 面罩吸氧治疗,高流量组实施 HFNCO 治疗。比较两组患者的氧合指标、左室射血分数 (LVEF),血栓再闭塞、冠状动脉搭桥术、急性左心衰、无创机械通气、气管插管发生率及预后指标。结果 出重症医学科 (ICU) 时,两组患者动脉血氧饱和度 (Sa O_(2))、动脉血氧分压 (Pa O_(2))均显著高于入组时,且高流量组 Sa O_(2)(97.3±2.6)%、Pa O_(2)(96.3±6.7)mm Hg(1 mm Hg=0.133 k Pa) 显著高于常规组的 (95.2±3.6)%、(92.6±6.1)mm Hg,差异有统计学意义 (P<0.05)。出 ICU 时,两组患者 p H、乳酸(Lac) 与入组时比较差异无统计学意义 (P>0.05);两组患者 p H、Lac 组间比较差异无统计学意义 (P>0.05)。出 ICU 时,两组患者 LVEF 均显著高于本组入组时,且高流量组 LVEF(48.66±5.82)% 显著高于常规组的(41.58±5.38)%,差异具有统计学意义 (P<0.05)。两组患者血栓再闭塞、冠状动脉搭桥术、气管插管发生率及住院病死率比较差异无统计学意义 (P>0.05);高流量组患者急性左心衰、无创机械通气发生率分别为 3.333%、3.333%,低于常规组的 23.333%、30.000%,入住 ICU 天数 (3.0±0.3)d 短于常规组的 (4.2±0.7)d,差异具有统计学意义 (P<0.05)。结论 HFNCO 有助于改善 PCI 术后 AMI 患者氧合指标及心功能。

Objective To discuss the clinical effect of high flow nasal cannula oxygen(HFNCO)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 60 patients with AMI after PCI were randomly divided into conventional group and high-flow group,with 30 cases in each group.The conventional group was treated with nasal cannula/mask oxygen therapy,and the high-flow group was treated with HFNCO.Both groups were compared in terms of oxygenation indexes,left ventricular ejection fraction(LVEF),thrombus reocclusion,coronary artery bypass grafting,acute left heart failure,non-invasive mechanical ventilation,incidence of tracheal intubation and prognostic indicators.Results When leaving the intensive care unit(ICU),the arterial oxygen saturation(SaO_(2))and arterial partial pressure of oxygen(PaO_(2))of the two groups were significantly higher than those of this group at the time of entry,and the SaO_(2)(97.3±2.6)%and PaO_(2)(96.3±6.7)mm Hg(1 mm Hg=0.133 kPa)in the high-flow group was significantly higher than(95.2±3.6)%and(92.6±6.1)mm Hg in the conventional group.All the differences were statistically significant(P<0.05).When leaving the ICU,there was no statistically significant difference in pH and lactic acid(Lac)in the two groups compared with those at the time of entry(P>0.05).There was no statistically significant difference in pH and Lac between the two groups(P>0.05).When leaving the ICU,the LVEF of the two groups was significantly higher than that of this group at the time of entry,and the LVEF(48.66±5.82)%of the high-flow group was significantly higher than(41.58±5.38)%of the conventional group.All the differences were statistically significant(P<0.05).The incidences of thrombus reocclusion,coronary artery bypass grafting,tracheal intubation and in-hospital mortality were compared between the two groups,and the differences were not statistically significant(P>0.05).The incidences of acute left heart failure and non-invasive mechanical ventilation in the high-flow group were 3.333%and 3.333%,which were lower than 23.333%and 30.000%in the conventional group,and the number of days in ICU(3.0±0.3)d was shorter than(4.2±0.7)d in the conventional group.All the differences were statistically significant(P<0.05).Conclusion HFNCO can help improve the oxygenation index and cardiac function of AMI patients after PCI.