经鼻高流量湿化氧疗治疗重症肺炎疗效及对患者血气指标和插管率的影响

Efficacy of high-flow nasal cannula oxygen therapy in treatment of severe pneumonia and its influence on blood gas indexes and intubation rate

目的:探究经鼻高流量湿化氧疗(HFNC)治疗重症肺炎(SP)的疗效及对血气分析指标和插管率的影响。方法:选取82例SP患者作为研究对象,采用随机数字表法分为两组,各41例。两组均给予对症治疗,对照组同时采用无创机械通气治疗,试验组采用HFNC治疗,比较两组患者疗效、治疗前后血气分析指标、插管率、痰液黏稠度以及并发症发生情况。结果:两组治疗有效率比较,试验组87.80%(36/41)高于对照组68.29%(28/41)(P<0.05);两组治疗后血气分析指标:氢离子浓度(pH)值、氧合指数(OI)比较差异无统计学意义(均P>0.05),试验组二氧化碳分压(PaCO_(2))、呼吸频率(RR)低于对照组,氧分压(PaO_(2))高于对照组(均P<0.05);试验组插管率4.88%与对照组的9.76%比较差异无统计学意义(P=0.675);两组治疗后痰液黏度Ⅱ级人数增加,Ⅲ、Ⅳ级减少,比较差异具有统计学意义(均P<0.05);两组并发症发生率比较,试验组4.88%(2/41)低于对照组9.76%(4/41),但两者比较差异无统计学意义(P>0.05)。结论:对SP患者采取HFNC治疗可改善疗效及血气分析指标且不增加插管率、改善痰液黏度、安全性高。

Objective:To investigate the efficacy of high-flow nasal cannula oxygen therapy(HFNC)in the treatment of severe pneumonia(SP),and its influence on blood gas indexes and intubation rate.Methods:A total of 82 patients with SP were randomly divided into two groups,with 41 cases in each group.Both groups were given symptomatic treatment.On this basis,the control group underwent non-invasive mechanical ventilation,while the experimental group underwent HFNC.The efficacy,blood gas indexes and sputum before and after treatment,viscosity intubation rate,and complications were compared between the two groups.Results:The treatment response rate in the experimental group was higher than that in the control group[87.80%(36/41)vs.68.29%(28/41),P<0.05].After treatment,there were no significant differences in pH and OI between the two groups(all P>0.05);the PaCO_(2) and RR in the experimental group were lower than those in the control group,and PaO_(2) was higher than that in the control group(all P<0.05).The intubation rates in the experimental group and the control group were 4.88%and 9.76%,without statistically significant difference between groups(P=0.675).After treatment,patients with gradeⅡsputum viscosity increased,and patients with gradeⅢandⅣsputum viscosity decreased in the two groups(all P<0.05).The incidence rate of complications in the experimental group was lower than that in the control group[4.88%(2/41)vs.9.76%(4/41),P>0.05].Conclusion:HFNC can improve the efficacy and blood gas indexes in the treatment of SP patients,and it does not increase the intubation rate and improves sputum viscosity,with high safety.