间质性肺炎急性加重期伴呼吸衰竭患者高流量鼻导管氧疗治疗无效的影响因素

Factors related to ineffectiveness of high flow nasal cannula oxygen therapy in patients with acute exacerbation of interstitial pneumonia with respiratory failure

目的分析间质性肺炎急性加重期(AE-IP)伴呼吸衰竭(RF)患者高流量鼻导管氧疗(HFNC)治疗无效的影响因素。方法选择白银市第一人民医院呼吸与危重症医学一部2019年8月至2021年8月136例AE-IP伴RF患者作为研究对象,记录患者资料,进行HFNC治疗,完成1周治疗后观察治疗效果,分为无效组、有效组,比较2组资料,使用Logistic回归分析检验,找出AE-IP伴RF患者HFNC治疗无效的影响因素。结果治疗1周,研究内136例AE-IP伴RF患者HFNC治疗无效发生率为16.91%(23/136);无效组呼吸道感染占比、营养不良占比均高于有效组,氧合指数低于有效组,B型钠尿肽(BNP)、降钙素原(PCT)均高于有效组,差异有统计学意义(P<0.05);其余资料比较,差异无统计学意义(P>0.05);Logistic回归分析结果显示,氧合指数、BNP、PCT、呼吸道感染、营养不良与AE-IP伴RF患者HFNC治疗无效有关,氧合指数低、BNP高、PCT高、呼吸道感染、营养不良可能是AE-IP伴RF患者HFNC治疗无效的风险因素(OR>1,P<0.05);森林图显示,在AE-IP伴RF患者HFNC治疗无效的相关因素中,营养不良的关联度最强。结论AE-IP伴RF患者HFNC治疗有一定的无效风险,可能与氧合指数低、BNP高、PCT高、呼吸道感染、营养不良有关。

Objective To identify the factors related to ineffectiveness of high flow nasal cannula(HFNC)oxygen therapy in patients with acute exacerbation of interstitial pneumonia(AE-IP)with respiratory failure(RF).Methods A total of 136 patients with AE-IP and RF who underwent HFNC oxygen therapy at Baiyin First People's Hospital from August 2019 to August 2021 were selected as the research subjects.After one week of treatment,the therapeutic effects were observed.Based on the therapeutic effects,the patients were divided into either an ineffective group or an effective group.The data were compared between the two groups.Logistic regression analysis was performed to identify the factors related to ineffectiveness of HFNC oxygen therapy in patients with AE-IP and RF.Results After one week of treatment,the ineffective rate of HFNC oxygen therapy in 136 patients with AE-IP and RF in the study was 16.91%(23/136).Compared with the effective group,the proportions of patients with respiratory tract infection and malnutrition were higher,the oxygenation index was lower,and the levels of arterial B-type natriuretic peptide(BNP)and procalcitonin(PCT)were significantly higher in the ineffective group(P<0.05).There was no significant difference in other data between the two groups(P>0.05).Logistic regression analysis showed that oxygenation index,BNP,PCT,respiratory tract infection,and malnutrition were related to the ineffectiveness of HFNC oxygen therapy in patients with AE-IP and RF.Low oxygenation index,high BNP,high PCT,respiratory tract infection,and malnutrition might be the risk factors for ineffectiveness of HFNC oxygen therapy in patients with AE-IP and RF(odds ratio>1,P<0.05).The forest plot showed that among the factors related to ineffectiveness of HFNC oxygen therapy in patients with AE-IP and RF,malnutrition had the strongest correlation.Conclusion There is a certain risk of ineffective HFNC oxygen therapy in patients with AE-IP and RF,and the ineffectiveness may be related to low oxygenation index,high BNP,high PCT,respiratory infection,and malnutrition.