经鼻高流量湿化氧疗对急性呼吸衰竭患者呼吸循环参数、凝血指标和并发症的影响

Effects of nasal high-flow humidified oxygen therapy on respiratory and circulatory parameters,coagulation parameters and complications in patients with acute respiratory failure

目的:通过与无创机械通气(non-invasive mechanical ventilation,NIV)对比,探讨经鼻高流量湿化氧疗(high-flow nasal cannula,HFNC)对急性呼吸衰竭(acute respiratory failure,ARF)患者呼吸循环参数、凝血指标和并发症的影响。方法:选取2018年9月至2020年8月池州市人民医院收治的ARF患者作为研究对象。根据氧疗方法不同将90例ARF患者分为HFNC组(n=45)与NIV组(n=45),HFNC组予以HFNC治疗,NIV组予以NIV治疗。比较2组治疗前后呼吸循环参数[呼吸频率(respiratory rate,RR)、脉搏血氧饱和度(pulse oxygen saturation,SpO_(2))、动脉二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))和氧合指数(arterial partial pressure of oxygen/fraction of inspiratory oxygen,PaO_(2)/FiO_(2))]、凝血功能指标[D-二聚体、纤维蛋白原(fibrinogen,Fib)]、舒适度评分、耐受性评分、并发症发生率和预后情况。结果:与治疗前相比,治疗48 h后2组RR降低(均P<0.05),PaO_(2)、PaCO_(2)和PaO_(2)/FiO_(2)水平增高(均P<0.05),2组呼吸与循环参数对比差异均无统计学意义(均P>0.05)。与治疗前相比,治疗48 h后2组D-二聚体、Fib水平均降低(均P<0.05),组间对比差异均无统计学意义(均P>0.05)。相比NIV组,HFNC组舒适度评分、耐受性评分均显著降低(均P<0.05)。HFNC并发症发生率为11.11%,显著低于NIV组的31.11%(P<0.05)。HFNC组48 h肺部感染率低于NIV组(P<0.05),2组气管插管率和28 d全因病死率对比差异均无统计学意义(均P>0.05)。结论:对于ARF的治疗,HFNC在改善呼吸循环参数和血液高凝状态方面的效果相当,但HFNC有更好的耐受性及较低的并发症发生率,安全性更好。

Objective:To investigate the effects of high-flow nasal cannula(HFNC)on respiratory and circulatory parameters,coagulation parameters and complications in patients with acute respiratory failure(ARF)by comparing with non-invasive ventilation(NIV).Methods:Patients with ARF admitted to Chizhou People’s Hospital from September 2018 to August 2020 were selected as the research objects.Ninety patients with ARF were divided into a HFNC group(n=45)and a NIV group(n=45)according to different oxygen therapies.The HFNC group was treated with HFNC,and the NIV group was treated with NIV.The respiratory and circulatory parameters[respiratory rate(RR),pulse oxygen saturation(SpO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),and oxygenation index(PaO_(2)/FiO_(2))],coagulation function indexes[D-dimer,fibrinogen(Fib)],comfort score,tolerance score,complication rate and prognosis in the 2 groups before and after the treatment were compared.Results:After 48 h of treatment,the RR in the 2 groups was lower than that before the treatment(P<0.05),and the levels of PaO_(2),PaCO_(2) and PaO_(2)/FiO_(2) were higher than those before the treatment(all P<0.05).There was no significant difference in respiratory and circulatory parameters between the 2 groups(all P>0.05).After 48 h of treatment,the levels of D-dimer and Fib in the 2 groups were lower than those before the treatment(both P<0.05),there was no significant difference between the 2 groups(both P>0.05).Compared with the NIV group,the scores of comfort and tolerance in the HFNC group were significantly lower(all P<0.05).The incidence rate of complications in HFNC group was 11.11%,which was significantly lower than 31.11%in the NIV group(P<0.05).The 48 h pulmonary infection rate in the HFNC group was lower than that in the NIV group(P<0.05).There was no significant difference in tracheal intubation rate and 28 d all-cause mortality between the 2 groups(both P>0.05).Conclusion:For the treatment of ARF,HFNC has the same effect in improving respiratory and circulatory parameters and blood hypercoagulation state,but HFNC has better tolerance,lower incidence of complications and better safety.