经鼻高流量氧疗在接受经皮冠脉介入术的急性心肌梗死患者中的临床应用

A study on the effects and safety of high-flow nasal cannula oxygen therapy in patients with acute myocardial infarction undergoing percutaneous coronary intervention

目的:探讨经鼻高流量氧疗(HFNCO)对接受冠脉介入术(PCI)后急性心肌梗死患者(AMI)的效果及安全性。方法:选择我院2017-10-01—2018-09-30期间经急诊医学科胸痛中心流程接受PCI术后收住院符合条件的73例AMI患者,按照随机数字表法将患者分别采用HFNCO(高流量组35例)和常规鼻导管/面罩氧疗(常规氧疗组38例)进行比较,观察其一般情况、氧合指标以及相关预后指标。结果:两组患者一般情况、胸痛中心相关质控指标以及氧合情况差异无统计学意义(P>0.05)。与入组时比较,出CCU时,高流量组PaO2明显常规氧疗组(95.5±18.3 vs.91.5±18.0,P<0.01),SaO2明显高于常规氧疗组(97.1±1.4 vs.95.6±1.8,P<0.01)。入组72 h高流量组射血分数明显大于常规氧疗组[(58.9±3.9)%vs.(53.6±4.5)%,P<0.05];与常规氧疗组相比,高流量组无创机械通气比例明显减少(2.9%vs.21.5%,P<0.05),CCU天数明显减少(2.7±0.5 vs.3.2±0.9,P<0.01)。结论:HFNCO有助于改善PCI术后AMI患者氧合及心功能。

Objective:To evaluate the effects and safety of high-flow nasal cannula oxygen therapy(HFNCO)in patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(PCI).Method:Seventy-three patients with AMI undergoing PCI,who were admitted to Huai’an First People’s Hospital affiliated to Nanjing Medical University from October 2017 to September 2018,were included in the study.The patients were performed HFNCO(high-flow group 35 cases)or conventional nasal cannula/mask oxygen therapy(conventional oxygen therapy group 38 cases)according to the random number table method.The general condition,oxygenation index and related prognostic indicators were observed.Result:There was no significant differences in the general condition,the quality control indicators of the chest pain center and the oxygenation status of the two groups(P>0.05).Compared with the enrollment,the PaO2(95.5±18.3 vs.91.5±18.0,P<0.01)and SaO2(97.1±1.4 vs.95.6±1.8,P<0.01)were significantly higher in HFNCO group than those in conventional oxygen therapy group.72 h after the enrollment the ejection fraction of the HFNCO group was significantly higher than that of the conventional oxygen therapy group((58.9±3.9)%vs.(53.6±4.5)%,P<0.01)Compared with the conventional oxygen therapy group,the proportion of NIV(2.9%vs.21.5%,P=0.032)and the duration of CCU(2.7±0.5 vs.3.2±0.9,P=0.006)in the HFNCO group were significantly reduced.Conclusion:Nasal high flow oxygen therapy can improve oxygenation and cardiac function in patients with AMI after PCI,and can be promoted in clinical use.