高流量氧疗联合无创呼吸通气治疗重症肺炎合并呼吸衰竭疗效观察

Efficacy of high-flow oxygen therapy combined with non-invasive respiratory ventilation in the treatment of severe pneumonia with respiratory failure

目的观察高流量氧疗联合无创呼吸通气治疗重症肺炎合并呼吸衰竭的临床疗效。方法选取2020年3月至2022年12月榆林市第二医院收治的110例重症肺炎合并呼吸衰竭患者作为研究对象,按随机数表法分为观察组和对照组各55例。对照组患者采用无创呼吸通气治疗,观察组患者采用无创呼吸机联合高流量氧疗,两组患者均治疗两周。于治疗后比较两组患者的临床疗效、临床症状消失时间、住院时间以及治疗前后的肺功能指标[第1秒最大呼气容积(FEV_(1))、用力肺活量(FVC)、最大自主分钟通气量(MVV)]、动脉血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血氧饱和度(SpO_(2))及酸碱度值(pH值)]和炎性因子水平[肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)、C-反应蛋白(CRP)],同时比较两组患者治疗期间的不良反应发生情况。结果观察组患者的治疗总有效率为96.36%,明显高于对照组的83.64%,差异有统计学意义(P<0.05);治疗后,观察组患者的发绀、气促、肺部啰音和三凹征的消失时间及住院时间均较对照组明显更短,差异均有统计学意义(P<0.05);治疗后观察组患者的FEV_(1)、FVC、MVV分别为(2.25±0.56)L、(3.05±0.41)L、(78.64±12.45)L,明显高于对照组的(1.89±0.26)L、(2.61±0.34)L、(70.12±10.56)L,差异均有统计学意义(P<0.05);治疗后,观察组患者的PaO_(2)、SpO_(2)、pH值分别为(92.06±6.41)mmHg、(93.16±3.02)%、7.40±0.04,明显高于对照组的(83.32±8.32)mm Hg、(90.16±2.03)%、7.30±0.05,PaCO_(2)为(40.32±4.26)mm Hg,明显低于对照组的(51.55±5.51)mm Hg,差异均有统计学意义(P<0.05);治疗后,观察组患者的TNF-α、IL-1、CRP分别为(4.85±1.01)ng/mL、(5.53±1.45)pg/mL、(7.89±1.54)mg/L,明显低于对照组的(7.89±1.32)ng/mL、(10.48±2.05)pg/mL、(15.46±3.54)mg/L,差异均有统计学意义(P<0.05);观察组患者治疗期间的不良反应总发生率为5.45%,明显低于对照组的18.18%,差异有统计学意义(P<0.05)。结论高流量氧疗联合无创呼吸通气治疗重症肺炎合并呼吸衰竭可有效改善患者的临床症状、体征以及肺功能,缩短疾病治疗周期,同时显著改善患者动脉血气分析指标以及炎性反应,安全性较高。

Objective To observe the clinical efficacy of high-flow oxygen therapy combined with non-inva-sive respiratory ventilation in the treatment of severe pneumonia with respiratory failure.Methods A total of 110 pa-tients with severe pneumonia combined with respiratory failure admitted to Yulin No.2 Hospital from March 2020 to De-cember 2022 were selected and randomly divided into an observation group and a control group,with 55 cases in each group.Patients in the control group were treated with non-invasive respiratory ventilation,while those in the observation group were treated with non-invasive ventilation combined with high-flow oxygen therapy,for 2 weeks.After treatment,the clinical efficacy,time of symptom disappearance,length of hospital stay,lung function indicators[maximum expira-tory volume(FEV_(1)),forced vital capacity(FVC),and maximum spontaneous minute ventilation(MVV)],arterial blood gas indicators[arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),blood oxygen sat-uration(SpO_(2)),and pH value],and levels of inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),and C-reactive protein(CRP),and the incidence of adverse reactions during treatment were compared between the two groups.Results The total effective rate of treatment in the observation group was 96.36%,significantly higher than 83.64%in the control group(P<0.05).After treatment,the disappearance time of cyanosis,shortness of breath,lung rales,and triple concave sign,and length of hospital stay in the observation group were significantly shorter than those in the control group(P<0.05).After treatment,the FEV_(1),FVC,and MVV of the observation group were(2.25±0.56)L,(3.05±0.41)L,and(78.64±12.45)L,respectively,significantly higher than(1.89±0.26)L,(2.61±0.34)L,and(70.12±10.56)L of the control group(P<0.05).After treatment,the PaO_(2),SpO_(2),and pH values of the observation group were(92.06±6.41)mmHg,(93.16±3.02)%,and 7.40±0.04,respectively,which were significantly higher than(83.32±8.32)mmHg,(90.16±2.03)%,and 7.30±0.05 of the control group(P<0.05).The PaCO_(2)value was(40.32±4.26)mmHg,which was sig-nificantly lower than(51.55±5.51)mmHg of the control group(P<0.05).After treatment,the TNF-α,IL-1,and CRP of the observation group were(4.85±1.01)ng/mL,(5.53±1.45)pg/mL,and(7.89±1.54)mg/L,respectively,significantly lower than(7.89±1.32)ng/mL,(10.48±2.05)pg/mL,and(15.46±3.54)mg/L in the control group(P<0.05).The total in-cidence of adverse reactions in the observation group was 5.45%,significantly lower than 18.18%in the control group(P<0.05).Conclusion High-flow oxygen therapy combined with non-invasive respiratory ventilation can effectively improve the clinical symptoms,signs,and lung function of patients with severe pneumonia complicated with respiratory failure,shorten the disease treatment cycle,and significantly improve arterial blood gas analysis indicators and inflamma-tory reactions,with high safety.