精细化气道管理对HFNC治疗EICU急性低氧性Ⅰ型呼吸衰竭患者的影响

The Effect of Refined Airway Management on HFNC Treatment of EICU Acute Hypoxic Type Ⅰ Respiratory Failure Patients

目的探究精细化气道管理对经鼻高流量湿化氧疗(HFNC)治疗急诊科监护室(EICU)急性低氧性Ⅰ型呼吸衰竭患者氧合、血气的影响。方法选择2022年1月至2022年12月期间在周口市中心医院收治的112例急性低氧性Ⅰ型呼吸衰竭患者作为研究对象,参照随机数表法将其分为对照组和观察组,各56例,对照组采用HFNC方式,观察组在对照组的基础上联合精细化管道护理进行干预。比较干预前及干预后(干预3 d后)两组患者的氧合指数及心率(HR)、呼吸频率(RR)、血气指标[二氧化碳分压(PaCO_(2))、动脉氧分压(PaO_(2))、血氧饱和度(SaO_(2))、pH值]、舒适程度[舒适状况评估量表(GCQ)]变化;探究两组患者干预期间不良反应发生差异。结果干预后,两组患者氧合指数有所提升,HR、RR有所下降,且观察组氧合指数高于对照组,HR及RR指标低于对照组,差异有统计学意义(P<0.05)。干预后,两组患者PaO_(2)、SaO_(2)、pH指标均有所提高,PaCO_(2)指标有所下降,且观察组的PaO_(2)、SaO_(2)、pH指标高于对照组,PaCO_(2)指标低于对照组,差异有统计学意义(P<0.05)。干预后,两组患者各项GCQ评分均有所提高,且观察组各项GCQ评分高于对照组,差异有统计学意义(P<0.05)。干预期间两组患者的胃肠胀气、吸入性肺炎、面罩压迫部位损伤、口咽不适及呼吸机相关性肺炎(VAP)发生率差异无统计学意义(P>0.05)。结论精细化气道管理可有效改善HFNC治疗EICU急性低氧性Ⅰ型呼吸衰竭患者的氧合指数及血气指标,帮助其舒适程度的提升。

Objective To explore the effect of refined airway management on the oxygenation and blood gas of patients with acute hypoxic type Ⅰ respiratory failure in the Emergency Department Intensive Care Unit(EICU)treated with High Flow Nasal Cannula(HFNC).Methods 112 patients with acute hypoxic type Ⅰ respiratory failure admitted to Zhoukou Central Hospital from January 2022 to December 2022 were selected as the research subjects.According to the random number table method,they were divided into the control group(56 cases,treated with HFNC)and the observation group(56 cases,combined with refined airway management on the basis of the control group).The oxygenation index and heart rate(HR),respiratory rate(RR),blood gas indicators[carbon dioxide partial pressure(PaCO_(2)),arterial oxygen partial pressure(PaO_(2)),blood oxygen saturation(SaO_(2)),pH value],comfort level[General comfort questionnaire(GCQ)]changes before and after intervention(3 days after intervention)of the two groups were compared;the difference in adverse reactions during the intervention of the two groups was explored.Results After intervention,the oxygenation index of both groups increased,and the vital signs(HR,RR)decreased.The oxygenation index of the observation group was higher than that of the control group,and the HR and RR indicators were lower than those of the control group,and the differences were statistically significant(P<0.05).After intervention,the PaO_(2),SaO_(2),and pH indicators of both groups increased,and the PaCO_(2)indicators decreased.The PaO_(2),SaO_(2),and pH indicators of the observation group were higher than those of the control group,and the PaCO_(2)indicators were lower than those of the control group,and the differences were statistically significant(P<0.05).After intervention,the GCQ scores of both groups increased,and the GCQ scores of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).During the intervention,the incidence of gastrointestinal bloating,aspiration pneumonia,mask pressure site injury,oropharyngeal discomfort,and ventilator-associated pneumonia(VAP)in the two groups was not statistically significant(P>0.05).Conclusion Refined airway management can effectively improve the oxygenation index and blood gas indicators of patients with acute hypoxic type Ⅰ respiratory failure in EICU treated with HFNC,and help improve their comfort level.