不同氧疗措施对肺源性心脏病伴Ⅱ型呼吸衰竭患者血气、心功能及凝血功能指标的影响

Effects of different oxygen therapy methods on blood gas analysis,cardiac function,and coagulation function indicators in patients with pulmonary heart disease complicated by typeⅡrespiratory failure

目的探讨经鼻高流量氧疗(HFNC)和鼻导管低流量氧疗对肺源性心脏病(PHD)伴Ⅱ型呼吸衰竭患者血气、心功能及凝血功能指标的影响,以期为该类患者的治疗方案选择提供参考。方法选取2022年1月—2023年6月阿坝藏族羌族自治州人民医院收治的134例PHD伴Ⅱ型呼吸衰竭患者为研究对象,采用随机数字表法分为观察组和对照组,每组67例。对照组患者接受鼻导管低流量氧疗,观察组患者接受HFNC治疗。比较2组患者的临床疗效,治疗前后的血气指标[血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、凝血功能指标[血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、D-二聚体(D-D)]、心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、脑利尿钠肽(BNP)]、肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、呼气流量峰值(PEF)]、炎症因子[C反应蛋白(CRP)、降钙素原(PCT)]等指标水平。结果观察组患者的治疗总有效率为92.54%(62/67),高于对照组的77.61%(52/67),差异有统计学意义(χ2=5.877,P=0.015)。治疗前,2组患者SpO_(2)、PaO_(2)、PaCO_(2)水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者SpO_(2)、PaO_(2)水平均高于治疗前且观察组均高于对照组,PaCO_(2)水平均低于治疗前且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者PT、APTT及Fg、D-D水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者PT、APTT均大于治疗前且观察组均大于对照组,Fg、D-D水平均低于治疗前且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者LVESD、LVEF及BNP水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者LVEF水平均高于治疗前且观察组高于对照组,BNP水平均低于治疗前且观察组低于对照组,LVESD均小于治疗前且观察组小于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者FEV1、FVC及PEF水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者FEV1、FVC及PEF水平均高于治疗前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者CRP及PCT水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者CRP及PCT水平均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。结论对于PHD伴Ⅱ型呼吸衰竭患者,相较于鼻导管低流量氧疗,HFNC在提高临床疗效,改善患者血气指标,促进患者心功能和凝血功能恢复等方面的效果更好。

Objective To explore the effects of high-flow nasal cannula(HFNC)oxygen therapy and low-flow nasal cannula oxygen therapy on blood gas analysis,cardiac function,and coagulation function indicators in patients with pulmonary heart disease(PHD)complicated by typeⅡrespiratory failure,aiming to provide a reference for treatment options for these patients.Methods From January 2022 to June 2023,patients with PHD complicated by typeⅡrespiratory failure treated at the People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture were randomly divided into observation and control groups,with 67 patients in each.The control group received low-flow nasal cannula oxygen therapy,while the observation group received HFNC therapy.The clinical efficacy,pre-and post-treatment blood gas indices[pulse oxygen saturation(SpO_(2)),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],coagulation function indices[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fg),D-dimer(D-D)],cardiac function indices[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),brain natriuretic peptide(BNP)],pulmonary function indices[forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),peak expiratory flow(PEF)],and inflammation markers,including C-reactive protein(CRP)and procalcitonin(PCT),were compared between the two groups.Results The overall treatment efficacy rate in the observation group was 92.54%(62/67),which was significantly higher than the 77.61%(52/67)observed in the control group(χ^(2)=5.877,P=0.015).Before treatment,no significant differences were noted between the two groups in SpO_(2),PaO_(2),and PaCO_(2)levels(P>0.05).After treatment,both groups showed improvements in SpO_(2)and PaO_(2)levels,with the observation group showing significantly higher levels compared to the control group,and a decrease in PaCO_(2)levels,with the observation group showing significantly lower levels than the control group(P<0.05).Before treatment,no significant differences were observed between the two groups in PT,APTT,Fg,and D-D levels(P>0.05).After treatment,PT and APTT levels were higher in both groups compared to pre-treatment levels,with the observation group showing significantly higher levels than the control group;Fg and D-D levels were lower in both groups compared to pre-treatment levels,with the observation group showing significantly lower levels than the control group(P<0.05).Before treatment,no significant differences were found in LVESD,LVEF,and BNP levels between the two groups(P>0.05).After treatment,LVEF levels were higher in both groups compared to pre-treatment levels,with the observation group showing significantly higher levels than the control group;BNP levels were lower in both groups compared to pre-treatment levels,with the observation group showing significantly lower levels than the control group;LVESD levels were smaller in both groups compared to pretreatment levels,with the observation group showing significantly lower levels than the control group(P<0.05).Before treatment,no significant differences were noted between the two groups in FEV1,FVC,and PEF levels(P>0.05).After treatment,FEV1,FVC,and PEF levels were higher in both groups compared to pre-treatment levels,with the observation group showing significantly higher levels than the control group(P<0.05).Before treatment,no significant differences were observed in CRP and PCT levels between the two groups(P>0.05).After treatment,CRP and PCT levels were lower in both groups compared to pre-treatment levels,with the observation group showing significantly lower levels than the control group(P<0.05).Conclusion For patients with PHD complicated by typeⅡrespiratory failure,HFNC therapy provides superior clinical efficacy,improving blood gas indices,cardiac function,and coagulation function more effectively than low-flow nasal cannula oxygen therapy.