无创呼吸机联合经鼻高流量氧疗序贯治疗对重症肺炎合并呼吸衰竭患者的治疗效果分析

Effect of Sequential Treatment of Non-invasive Ventilation Combined with Highflow Nasal Cannula Oxygen Therapy on Severe Pneumonia Complicated with Respiratory Failure

目的探讨无创呼吸机(non-invasive ventilation,NIV)联合经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)序贯治疗对重症肺炎合并呼吸衰竭患者的治疗效果。方法前瞻性选取2021年1月—2023年7月在江苏省扬州市江都人民医院接受治疗的96例重症肺炎合并呼吸衰竭患者为研究对象,采用随机数表法分为对照组和干预组,每组48例,均接受常规治疗。对照组患者接受NIV干预治疗,观察组接受NIV联合HFNC序贯治疗。比较两组治疗前后的临床症状和血气指标,记录随访1个月期间的再插管和不良反应。结果治疗后48 h,两组患者的呼吸频率和二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))降低,血氧饱和度(oxygen saturation,SPO_(2))、氧合指数血氧分压/氧浓度分数(oxygen tension/fraction of inspiration O_(2),PaO_(2)/FiO_(2))升高,研究组呼吸频率、PaCO_(2)水平低于对照组,SPO_(2)、PaO_(2)/FiO_(2)高于对照组,差异有统计学意义(P<0.05)。治疗后1个月,研究组不良事件发生率为4.16%(2/48),低于对照组的18.75%(9/48),差异有统计学意义(χ^(2)=5.031,P<0.05)。结论NIV联合HFNC序贯治疗可以明显改善重症肺炎合并呼吸衰竭患者的呼吸和心率,缩短ICU住院时间,加快改善患者的血气指标,并减少不良事件,具有一定安全性。

Objective To investigate the therapeutic effect of non-invasive ventilation(NIV)combined with high-flow nasal cannula oxygen therapy(HFNC)sequential therapy on patients with severe pneumonia complicated with respiratory failure.Methods A total of 96 patients with severe pneumonia complicated with respiratory failure who were treated in Yangzhou Jiangdu People's Hospital from January 2021 to July 2023 were prospectively selected as the research objects.They were divided into control group and intervention group by random number table method,with 48 cases in each group.All patients received routine treatment.Patients in the control group received NIV intervention treatment,and patients in the observation group received NIV combined with HFNC sequential treatment.The clinical symptoms and blood gas indexes of the two groups before and after treatment were compared,and the re-intubation and adverse events during the 1-month follow-up were recorded.Results 48 h after treatment,the respiratory rate and partial pressure of carbon dioxide(PaCO2)decreased,while blood oxygen saturation(SPO2),oxygenation index,blood oxygen pressure/fraction of inspiration O2(PaO2/FiO2)increased,of the two groups,the respiratory rate and PaCO2 levels of the study group were lower than those of the control group,while SPO2 and PaO2/FiO2 were higher than those of the control group,the differences were statistically significant(P<0.05).One month after treatment,the incidence of adverse events in the study group was 4.16%(2/48),lower than the control group's 18.75%(9/48),the differences was statistically significant(χ^(2)=5.031,P<0.05).Conclusion NIV combined with HFNC sequential treatment can significantly improve the respiratory and heart rate of patients with severe pneumonia complicated with respiratory failure,shorten the length of ICU stay,accelerate the improvement of patients'blood gas indexes,and reduce adverse events,with certain safety.