HFNC对成人重症肺炎合并呼吸衰竭患者血气指标、炎症因子和病情的影响

Effect of high-flow nasal cannula on blood gas parameters,inflammatory markers,and clinical conditions in adult patients with severe pneumonia and respiratory failure

目的探讨经鼻高流量氧疗(high-flow nasal cannula,HFNC)对成人重症肺炎合并呼吸衰竭患者的血气指标、炎症因子和病情的影响,并与无创正压通气(noninvasive positive pressure ventilation,NIPPV)的疗效进行比较。方法回顾性分析2021年1月至2023年10月期间延安市中医医院95例成人重症肺炎合并呼吸衰竭患者。接受NIPPV治疗的45例患者作为对照组,接受HFNC治疗的50例患者作为观察组。观察组男28例,女22例,年龄(63.64±4.31)岁;对照组男24例,女21例,年龄(64.38±4.57)岁。比较两组患者治疗前及治疗1周后的血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))]、呼吸频率(RR)、痰液黏稠度、炎症因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、高迁移率族蛋白B1(HMGB-1)、高敏C反应蛋白(hs-CRP)和可溶性髓样细胞触发受体(sTREM)]、病情变化[Borg分级量表以及肺炎严重指数(PSI)评分]及治疗效果、并发症。采用独立样本t检验、χ^(2)检验。结果治疗后,观察组PaO_(2)、RR、PaCO_(2)和SaO_(2)分别为(92.19±5.76)mmHg(1 mmHg=0.133 kPa)、(20.71±2.81)次/min、(45.99±5.33)mmHg、(93.30±9.39)%,对照组分别为(82.99±6.33)mmHg、(23.68±2.96)次/min、(48.19±5.76)mmHg、(83.50±9.43)%,两组差异均有统计学意义(均P<0.05)。观察组治疗后痰液黏稠度低于对照组(P=0.017)。观察组患者治疗后炎症因子水平较治疗前下降,且与对照组相比差异均有统计学意义[治疗后观察组TNF-α、IL-6、HMGB-1、hs-CRP和sTREM水平分别为(17.83±5.70)mg/L、(19.46±5.47)ng/L、(113.05±28.36)μg/L、(33.23±4.08)mg/L、(15.95±2.68)ng/L,对照组分别为(32.02±7.44)mg/L、(33.50±5.62)ng/L、(216.46±25.11)μg/L、(53.91±6.14)mg/L、(35.89±4.49)ng/L](均P<0.001)。治疗后,观察组Borg指数和PSI评分分别为(3.48±0.39)、(67.99±7.82)分,均低于对照组的(4.34±0.48)、(78.97±8.98)分,差异均有统计学意义(均P<0.001)。观察组撤机时间、住院时间、呼吸困难缓解时间、肺啰音消失时间分别为(3.63±0.72)、(7.75±1.16)、(1.04±0.36)、(4.32±0.77)d,均短于对照组的(4.75±0.85)、(8.46±1.33)、(1.64±0.51)、(5.88±1.06)d,差异均有统计学意义(均P<0.05)。两组患者并发症总发生率差异无统计学意义(P>0.05)。结论HFNC治疗对成人重症肺炎合并呼吸衰竭患者具有积极的疗效,能够有效改善血气指标、炎症因子和降低痰液黏稠度,促进病情恢复。

Objective To investigate the effects of high-flow nasal cannula(HFNC)on blood gas parameters,inflammatory markers,and clinical conditions in adult patients with severe pneumonia and respiratory failure,and compare the efficacy of noninvasive positive pressure ventilation(NIPPV)with it.Methods A retrospective analysis was performed on 95 adult patients with severe pneumonia and respiratory failure treated in Yan'an Hospital of Traditional Chinese Medicine from January 2021 to October 2023.Forty-five patients who received NIPPV were assigned to the control group,and 50 patients who underwent HFNC treatment were assigned to the observation group.In the observation group,there were 28 males and 22 females,aged(63.64±4.31)years.In the control group,there were 24 males and 21 females,aged(64.38±4.57)years.The two groups were compared in terms of blood gas parameters[arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO_(2)),and oxygen saturation(SaO_(2))],respiratory rate(RR),sputum viscosity,inflammatory markers[tumor necrosis factor(TNF)-α,interleukin(IL)-6,high mobility group protein B1(HMGB-1),high-sensitivity C-reactive protein(hs-CRP),and soluble myeloid cell trigger receptor(sTREM)],and changes in condition[Borg scale and Pneumonia Severity Index(PSI)scores]before treatment and 1 week after treatment,treatment efficiency,and complications.Independent sample t test andχ^(2) test were used.Results After treatment,thePaO_(2),RR,PaCO_(2),and SaO_(2) intheobservationgroupwere(92.19±5.76)mmHg(1 mmHg=0.133 kPa),(20.71±2.81)times/min,(45.99±5.33)mmHg,and(93.30±9.39)%,those in the control group were(82.99±6.33)mmHg,(23.68±2.96)times/min,(48.19±5.76)mmHg,and(83.50±9.43)%,with statistically significant differences between the two groups(all P<0.05).The phlegm viscosity of the observation group was lower than that of the control group after treatment(P=0.017).The levels of inflammatory factors in the observation group decreased after treatment compared with those before treatment,and there were statistically significant differences compared with those in the control group[the levels of TNF-α,IL-6,HMGB-1,hs-CRP,and sTREM in the observation group were(17.83±5.70)mg/L,(19.46±5.47)ng/L,(113.05±28.36)μg/L,(33.23±4.08)mg/L,and(15.95±2.68)ng/L,and those in the control group were(32.02±7.44)mg/L,(33.50±5.62)ng/L,(216.46±25.11)μg/L,(53.91±6.14)mg/L,and(35.89±4.49)ng/L](all P<0.001).After treatment,the Borg index and PSI scores of the observation group were(3.48±0.39)and(67.99±7.82)points,which were lower than those of the control group[(4.34±0.48)and(78.97±8.98)points],with statistically significant differences(both P<0.001).The weaning time,hospital stay,dyspnea relief time,and disappearance time of pulmonary rales in the observation group were(3.63±0.72),(7.75±1.16),(1.04±0.36),and(4.32±0.77)d,which were shorter than those in the control group[(4.75±0.85),(8.46±1.33),(1.64±0.51),and(5.88±1.06)d],with statistically significant differences(all P<0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion HFNC therapy has a positive effect on adult patients with severe pneumonia and respiratory failure,effectively improving blood gas parameters,reducing inflammatory markers,and decreasing sputum viscosity,thus facilitating recovery.