经鼻高流量湿化氧疗对成年人支气管哮喘急性发作期精准氧疗的可行性研究

Feasibility of HFNC on accurate oxygen therapy of adult bronchial asthma at acute attack

目的:探讨经鼻高流量氧疗(HFNC)对成年人支气管哮喘急性发作伴Ⅰ型呼吸衰竭治疗的临床价值。方法:选取医院呼吸内科收治的160例支气管哮喘急性发作伴Ⅰ型呼吸衰竭患者,采用随机数表法将其分为观察组和对照组,每组80例。两组患者均进行基础治疗,观察组采取HFNC方法氧疗,对照组采取常规方式氧疗;对比两组患者治疗前后心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(OI)、呼气末跨肺压、吸气末跨肺压及临床疗效的差异。结果:治疗后24 h和48 h,观察组的HR值均低于对照组,差异有统计学意义(t=-3.067,t=-4.057;P<0.05);观察组治疗后24 h的RR值低于对照组,OI高于对照组,差异有统计学意义(t=-3.027,t=3.291;P<0.05)。治疗后24 h和48 h,观察组的PaO2值均高于对照组,差异有统计学意义(t=3.571,t=4.528;P<0.05)。治疗后1周,观察组疗效的显效率、有效率和无效率分别为61.25%、36.25%和2.50%,对照组分别为45.00%、43.75%和6.25%,两组疗效差异有统计学意义(Z=-2.148,P<0.05)。结论:HFNC对成年人支气管哮喘急性发作伴Ⅰ型呼吸衰竭较常规氧疗更有利于改善患者的血气、血动力学参数,对于提高临床疗效具有积极作用。

Objective:To investigate the clinical value of high-flow nasal cannula(HFNC)in treating the acute attack of adult bronchial asthma that combined with type I respiratory failure.Methods:160 patients with acute attack of bronchial asthma combined with type I respiratory failure who admitted to respiratory department of hospital were randomly divided into the observation group and the control group according to random number table,with 80 patients in each group.Both groups adopted the same basic treatment measures.The observation group adopted HFNC oxygen therapy,while the control group adopted conventional oxygen therapy.The heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(OI),end expiratory trans pulmonary pressure,end inspiratory trans pulmonary pressure and clinical efficacy between two groups were compared before and after treatment.Results:At 24h and 48h after treatment,HR values in observation group were significantly lower than those in control group(t=-3.067,t=-4.057,P<0.05),respectively.The RR value in observation group was significantly lower than those in control group 24h after treatment(t=3.027,P<0.05).The PaO2 values of observation group were significantly higher than those of control group 24 h and 48 h after treatment(t=3.571,t=4.528,P<0.05),respectively.The OI value of observation group 24 h after treatment was significantly higher than that of control group(t=3.291,P<0.05).After one week of treatment,the significant effective rate,effective rate and ineffective rate in observation group were 61.25%,36.25%and 2.50%,respectively.Those of control group were 45.00%,43.75%and 6.25%.The curative effect of observation group was significantly superior to that of control group(Z=-2.148,P<0.05).Conclusion:Compared with conventional oxygen therapy,HFNC is more conducive to improving the blood gas and hemodynamic parameters of adult patients with acute attack of bronchial asthma combined with type I respiratory failure,which has a positive effect on improving the clinical efficacy.