经鼻高流量氧疗在海水淹溺肺水肿患者中的应用

Application of high flow nasal canula in patients with pulmonary edema caused by seawater drowning

目的探讨经鼻高流量氧疗(HFNC)和无创正压通气(NPPV)对海水淹溺肺水肿患者的治疗效果。方法采用回顾性分析方法,基于秦皇岛市第一医院急诊淹溺Utstein数据库,收集2019年1月1日至2022年12月31日秦皇岛市第一医院急诊科收治的海水淹溺肺水肿患者的临床资料。根据通气方式的不同分为NPPV组和HFNC组。比较两组患者的一般资料、7 d气管插管率、治疗前后动脉血气分析指标〔动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))〕和血流动力学指标(收缩压、舒张压、平均动脉压、心率、血乳酸)、重症监护病房(ICU)住院时间、氧疗舒适度。结果共纳入54例患者,其中NPPV组21例,HFNC组33例。两组患者性别、年龄、意识状态等一般资料比较差异均无统计学意义。与NPPV组比较,HFNC组7 d内行气管插管率明显降低〔24.2%(8/33)比33.3%(7/21),P<0.05〕。治疗前,两组患者动脉血气分析指标和血流动力学指标比较差异均无统计学意义;治疗后,两组患者上述指标均较本组治疗前明显改善,且HFNC组PaO_(2)、SaO_(2)、收缩压、舒张压和平均动脉压均明显高于NPPV组〔PaO_(2)(mmHg,1 mmHg≈0.133 kPa):93.56±6.37比82.14±6.25,SaO_(2):1.02±0.09比0.95±0.11,收缩压(mmHg):117.37±8.43比110.42±8.38,舒张压(mmHg):79.43±7.61比72.21±4.32,平均动脉压(mmHg):92.34±6.32比85.12±5.38〕,PaCO_(2)、心率和血乳酸水平均明显低于NPPV组〔PaCO_(2)(mmHg):34.26±5.63比37.24±6.22,心率(次/min):73.38±7.56比86.25±5.41,血乳酸(mmol/L):1.38±0.36比2.25±1.14〕,差异均有统计学意义(均P<0.05)。此外,HFNC组患者的ICU住院时间明显短于NPPV组(d:13.30±2.38比16.27±4.26),氧疗舒适率明显高于NPPV组〔66.7%(22/33)比42.9%(9/21)〕,差异均有统计学意义(均P<0.05)。结论HFNC可改善海水淹溺肺水肿患者的动脉氧合情况,改善血流动力学,降低气管插管率,缩短ICU住院时间,提高氧疗舒适度,具有一定的临床应用价值。

Objective To investigate the therapeutic effect of high-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NPPV)on patients with pulmonary edema caused by seawater drowning.Methods A retrospective analysis method was used.Based on the Utstein database of emergency drowning in the First Hospital of Qinhuangdao,the clinical data of patients with seawater drowning pulmonary edema admitted to the emergency medicine department of the First Hospital of Qinhuangdao from January 1,2019 to December 31,2022 were collected.The patients were divided into NPPV group and HFNC group according to different ventilation methods.The general data,endotracheal intubation rate in 7 days,arterial blood gas analysis indexes[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),arterial oxygen saturation(SaO_(2))]and hemodynamic indexes(systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,blood lactic acid)before and after treatment,length of stay in intensive care unit(ICU),oxygen therapy comfort of the two groups were compared.Results A total of 54 patients were enrolled,including 21 patients in the NPPV group and 33 patients in the HFNC group.There were no significant differences in gender,age,state of consciousness and other general information between the two groups.Compared with NPPV group,the rate of endotracheal intubation in HFNC group within 7 days was significantly lower[24.2%(8/33)vs.33.3%(7/21),P<0.05].Before treatment,there were no significant differences in arterial blood gas analysis and hemodynamics between the two groups.After treatment,the above indexes in both groups were significantly improved compared with those before treatment,and PaO_(2),SaO_(2),systolic blood pressure,diastolic blood pressure and mean arterial pressure in HFNC group were significantly higher than those in NPPV group[PaO_(2)(mmHg,1 mmHg≈0.133kPa):93.56±6.37 vs.82.14±6.25,SaO_(2):1.02±0.09 vs.0.95±0.11,systolic blood pressure(mmHg):117.37±8.43 vs.110.42±8.38,diastolic blood pressure(mmHg):79.43±7.61 vs.72.21±4.32,mean arterial pressure(mmHg):92.34±6.32 vs.85.12±5.38],PaCO_(2),heart rate and blood lactic acid were significantly lower than those in NPPV group[PaCO_(2)(mmHg):34.26±5.63 vs.37.24±6.22,heart rate(times/min):73.38±7.56 vs.86.25±5.41,blood lactic acid(mmol/L):1.38±0.36 vs.2.25±1.14],and the differences were statistically significant(all P<0.05).In addition,the length of ICU stay in HFNC group was significantly shorter than that in NPPV group(days:13.30±2.38 vs.16.27±4.26),and the comfort rate of oxygen therapy was significantly higher than that in NPPV group[66.7%(22/33)vs.42.8%(9/21)],with statistical significance(all P<0.05).Conclusion HFNC can improve the oxygenation of patients with pulmonary edema caused by seawater drowning,improve hemodynamics,reduce the rate of tracheal intubation,shorten the length of ICU stay,and improve the comfort of oxygen therapy,which has certain clinical application value.