经鼻高流量氧疗治疗老年重症肺炎的临床疗效和安全性

Clinical Efficacy and Safety of Nasal High-flow Oxygen Therapy in Elderly Patients with Severe Pneumonia

目的探讨对老年重症肺炎患者采用经鼻高流量氧疗方法(HFNC)完成治疗后对其临床疗效以及安全性产生的影响。方法选取2018年1月至2022年6月我科收治的60例老年重症肺炎患者进行本次治疗研究;采用随机数字表法对所有入选患者进行分组,即研究组30例,接受经鼻高流量氧疗治疗;对照组30例,接受无创机械通气治疗;比较两组临床治疗效果、治疗24 h前后呼吸频率(R)及血气分析结果[PH、PaO_(2)/FiO_(2)(氧合指数)、动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))]、不良事件(气管插管、气道干燥、焦虑、腹胀)总发生率。结果研究组治疗后的总体疗效高于对照组(P<0.05);治疗24 h前后,研究组呼吸频率下降较对照组明显[RR(21.55±0.92)次/分vs.(24.21±1.89)次/分](P<0.05),两组在血气分析结果改善方面未呈现出明显差异[pH:(7.40±0.05)vs.(7.39±0.09);氧合指数:(237.41±48.35)mm Hg vs.(240.21±55.25)mm Hg;PaO_(2):(83.29±15.39)mm Hg vs.(80.97±15.11)mm Hg;PaCO_(2):(41.41±12.69)mm Hg vs.(40.05±7.75)mm Hg](P>0.05);对两组患者安全性实施评定,研究组不良事件总发生率低于对照组,差异有统计学意义(P<0.05)。结论经鼻高流量氧疗治疗相较于无创机械通气治疗老年重症肺炎的疗效相当,但经鼻高流量氧疗的不良事件发生率更低,更易被老年患者所接受,可促进老年重症肺炎患者的良好预后。

Objective To explore the effect of nasal high-flow oxygen therapy on the clinical efficacy and safety of elderly patients with severe pneumonia.Methods A total of 60 elderly patients with severe pneumonia admitted from January 2018 to November 2021 were selected for this treatment study.All elderly patients with severe pneumonia were divided into different groups by random number table.The control group(n=30)received non-invasive mechanical ventilation.The study group(n=30)received nasal high-flow oxygen therapy.The treatment effect,the total incidence of complications(respiratory obstruction,heart failure,delirium,septic shock,multiple organ failure),and the results of blood gas analysis[PH(hydrogen ion concentration index),RR(respiratory rate),OI(oxygenation index),PO_(2)(partial pressure of oxygen),PCO_(2)(partial pressure of carbon dioxide)]were compared between the two groups.Results After the completion of treatment,the efficacy of the two groups was evaluated.The overall efficacy of the study group was significantly higher than that of the reference group(P<0.05).There was no significant difference in the total incidence of complications(respiratory obstruction,heart failure,delirium,septic shock,multiple organ failure)between the two groups(P>0.05).There was no significant difference in the improvement of blood gas analysis results between the two groups[pH:(7.40±0.05)vs.(7.39±0.09);IO:(237.41±48.35)mm Hg vs.(240.21±55.25)mm Hg;PaO_(2):(83.29±15.39)mm Hg vs.(80.97±15.11)mm Hg;PaCO_(2):(41.41±12.69)mm Hg vs.(40.05±7.75)mm Hg](P>0.05).Conclusion Nasal high-flow oxygen therapy has a better effect than non-invasive mechanical ventilation in the treatment of elderly patients with severe pneumonia,and the safety is similar.The total incidence of adverse events in the study group was significantly lower than that in the reference group.