经鼻高流量氧疗与非重复呼吸面罩给氧治疗轻度一氧化碳中毒的比较

Comparison of high-flow nasal cannula oxygen therapy and non-rebreather face mask in the treatment of mild carbon monoxide poisoning

目的对比经鼻高流量氧疗(HFNC)和非重复呼吸面罩(NRFM)给氧治疗轻度急性一氧化碳中毒(ACOP)降低碳氧血红蛋白(COHb)的效果,探讨HFNC治疗ACOP的可行性。方法分析2015年1月至2020年12月就诊于苏北人民医院急诊科COHb>10%的轻度ACOP患者,排除意识改变、机械通气及需高压氧治疗者。根据在急诊使用的氧疗方式将患者分为HFNC组和NRFM组。观察两组COHb下降值及COHb半衰期等指标变化。结果入选71例患者,其中NRFM组39例,HFNC组32例。HFNC组基线COHb为24.8%±8.3%,NRFM组为22.5%±7.1%,两组差异无统计学意义(t=1.27,P=0.094)。治疗60 min、90 min及120 min时,两组COHb均下降,但同时间点HFNC组COHb均低于NRFM组(P<0.05)。治疗1 h后,HFNC组COHb下降值(16.9%±4.5%)明显高于NRFM组(10.1%±7.8%)(t=4.32,P=0.013)。HFNC组COHb平均半衰期(39.3 min)明显低于NRFM组(61.4 min)(t=4.69,P=0.034)。结论HFNC治疗轻度ACOP能快速降低血COHb水平,是临床治疗ACOP有潜力的氧疗方式。

Objective To compare the efficacy of high-flow nasal cannula oxygen therapy(HFNC)and non-rebreather face mask(NRFM)in the treatment of mild acute carbon monoxide poisoning(ACOP)in reducing carboxyhemoglobin(COHb),and to explore the feasibility of HFNC in the treatment of ACOP.Methods Patients with mild ACOP with COHb>10%who were admitted to the emergency department of Northern Jiangsu People's Hospital from January 2015 to December 2020 were analyzed,and those with altered consciousness,mechanical ventilation and those requiring hyperbaric oxygen therapy were excluded.The patients were divided into HFNC group and NRFM group according to the oxygen therapy used in the emergency department.The COHb decline value and COHb half-life in the two groups were observed.Results Seventy-one patients were enrolled,including 39 in the NRFM group and 32 in the HFNC group.The baseline COHb in the HFNC group was 24.8%±8.3%,and that in the NRFM group was 22.5%±7.1%,with no significant difference between the two groups(t=1.27,P=0.094).At 60 min,90 min and 120 min of treatment,COHb in both groups decreased,but the COHb in HFNC group was lower than that in NRFM group at the same time point(P<0.05).After 1 h of treatment,the COHb decrease in the HFNC group(16.9%±4.5%)was significantly higher than that in the NRFM group(10.1%±7.8%)(t=4.32,P=0.013).The mean half-life of COHb in the HFNC group(39.3 min)was significantly lower than that in the NRFM group(61.4 min)(t=4.69,P=0.034).Conclusion HFNC treatment of mild ACOP can rapidly reduce blood COHb level,it is a potential oxygen therapy method for clinical treatment of ACOP.