经鼻高流量湿化氧疗应用于重症Ⅰ型呼吸衰竭患者的临床研究

Study of high flow nasal cannula oxygen therapy in patients with severe typeⅠrespiratory failure

目的分析高流量氧疗(high flow nasal cannulaoxygen therapy,HFNC)对重症Ⅰ型呼吸衰竭患者动脉血气、呼吸力学的影响。方法将浙江省临海市第一人医院2020年1月至2021年1月收治的60例重症Ⅰ型呼吸衰竭患者,采用随机数字表法分为无创正压通气(noninvasive positive pressure ventilation,NPPV)组与HFNC组,每组各30例,分别给予NPPV、HFNC通气治疗,比较两组患者的动脉血气、呼吸力学指标、喂养及治疗情况。结果①两组pH值、动脉血二氧化碳分压(partial pressure of carbon dioxide in artery,PaCO_(2))组间、时点间、组间·时点间交互比较,差异均无统计学意义(P>0.05),但HFNC组通气48h的动脉血氧分压(partial pressure of arterial oxygen,PaO_(2))、氧合指数(oxygenation index,OI)显著高于NPPV组(P<0.05);②两组呼吸频率(respiratory rate,RR)、吸气末跨肺压(dynamic end-inspiratory transpulmonary pressure,P_(L,ei))、呼气末跨肺压(end-expiratory transpulmonary pressure,P_(L,ee))、驱动压(driving transpulmonary pressure,△PL)组间、时点间、组间·时点间交互比较,差异均无统计学意义(P>0.05);③两组营养供给途径、重症监护室(intensive care unit,ICU)住院天数比较,差异无统计学意义(P>0.05),但HFNC组腹胀发生率、吞咽障碍评分、口腔干燥程度评分显著低于NPPV组(P<0.05),舒适度评分高于NPPV组(P<0.05)。结论较NPPV,HFNC同样可改善重症Ⅰ型呼吸衰竭患者、呼吸力学指标水平,且HFNC对PaO_(2)、OI的改善更显著。

Objective To analyze the effect of high flow nasal cannula oxygen therapy(HFNC)on arterial blood gas,respiratory mechanics and 28d mortality rate in patients with severe typeⅠrespiratory failure.Methods Sixty patients with severe typeⅠrespiratory failure admitted to the hospital from January 2020 to January 2021 were divided into noninvasive positive pressure ventilation(NPPV)group and HFNC group according to the random number table method,30 cases in each group,received NPPV and HFNC,respectively.Arterial blood gas,respiratory mechanics indicators,feeding and treatment conditions were compared between the two groups.Results①There was no statistically significant difference in pH or arterial partial pressure of carbon dioxide(PaCO_(2))in terms of inter-group effect,time effect and interaction effect(P>0.05).The arterial partial pressure of oxygen(PaO_(2))and oxygenation index(OI)in HFNC group were significantly higher than those in NPPV group after 48h of ventilation(P<0.05).②There was no statistically significant difference in respiratory rate(RR),dynamic end-inspiratory transpulmonary pressure(P_(L,ei)),end-expiratory transpulmonary pressure(P_(L,ee))or driving transpulmonary pressure(△PL)in terms of inter-group effect,time effect and interaction effect(P>0.05).③There was no statistically significant difference in the way of nutrition supply,length of Intensive Care Unit stay between the two groups(P>0.05).The incidence rate of abdominal distension,dysphagia score,oral dryness degree score in HFNC group were significantly lower than those in NPPV group(P<0.05).The comfort score was higher than that in NPPV group(P<0.05).Conclusion Compared with NPPV,HFNC can improve respiratory mechanics in patients with severe typeⅠrespiratory failure.HFNC can improve PaO_(2)and OI more significantly.