High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.

High-flow nasal cannula oxygen therapy during anesthesia recovery for older orthopedic surgery patients: A prospective randomized controlled trial

BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM To investigate the clinical efficacy of high-flow nasal cannula oxygen(HFNCO)in the resuscitation period of older orthopedic patients.METHODS In this prospective randomized controlled trial,60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups:those who used conventional face mask and those who used HFNCO.All patients were treated with 60%oxygen for 1 h after extubation.Patients in the conventional face mask group were treated with a combination of air(2 L)and oxygen(2 L)using a traditional mask,whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34℃ and flow rate of 40 L/min.We assessed the effectiveness of oxygen therapy by monitoring the patients’arterial blood gas,peripheral oxygen saturation,and postoperative complications.RESULTS The characteristics of the patients were comparable between the groups.One hour after extubation,patients in HFNCO group had a significantly higher arterial partial pressure of oxygen(paO_(2))than that of patients in conventional face mask group(P<0.001).At extubation and 1 h after extubation,patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide(paCO_(2))than the baseline levels(P<0.001).There were no differences in the saturation of peripheral oxygen,paO_(2),and paCO_(2) between the groups before anesthesia and before extubation(P>0.05).There were statistically significant differences in paO_(2) between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation(P<0.001).However,there were no significant differences in the oxygen tolerance score before leaving the room,airway humidification,and pulmonary complications 3 d after surgery between the two groups(P>0.05).CONCLUSION HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia.Thus,HFNCO can be used to prevent postoperative hypoxemia.

Sleep Quality for Patients Receiving Noninvasive Positive Pressure Ventilation and Nasal High-Flow Oxygen Therapy in an ICU: Two Case Studies

Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.

Particle characteristics and rheological constitutive relations of high concentration red mud

Red mud has relatively small solid particles （d50= 13.02 μm） and will flow in paste form under high pressure during pipeline transport. Red mud belongs to a two-phase flow of materials with high viscosity and a high concentration of non-sedimentation, homogeneous solid-liquids. It is difficult to test its rheological properties under atmospheric pressure. Measurements such as rotational viscometry can not reflect the real state of the material when it is flowing in a pipe. Tested rheological parameters are somewhat higher than the actual values. In our investigation, grain shape, distinctive modality and grain size distribution of red mud were tested. Based on the principle of tube measurement, rheological experiments on red mud at different concentrations were carried out by using our independently developed tube-type pressure theology test facility, and obtained constitutive equations. We conclude that red mud behaves as non-Newtonian pseudo-plastic fluid in pipe flows. Its consistency and power-law indices vary considerably with different concentrations.

Effects of oxygen concentration and flow rate on cognitive ability and physiological responses in the elderly

The supply of highly concentrated oxygen positively affects cognitive processing in normal young adults. However, there have been few reports on changes in cognitive ability in elderly subjects following highly concentrated oxygen administration. This study investigated changes in cognitive ability, blood oxygen saturation （%）, and heart rate （beats/min） in normal elderly subjects at three different levels of oxygen [21% （1 L/min）, 93% （1 L/min）, and 93% （5 L/min）] administered during a 1-back task. Eight elderly male （75.3 ＋ 4.3 years old） and 10 female （71.1 ＋ 3.9 years old） subjects, who were normal in cognitive ability as shown by a score of more than 24 points in the Mini-Mental State Examination-Korea, participated in the experiment. The experiment consisted of an adaptation phase after the start of oxygen administration （3 minutes）, a control phase to obtain stable baseline measurements of heart rate and blood oxygen saturation before the task （2 minutes） and a task phase during which the 1-back task was performed （2 minutes）. Three levels of oxygen were administered throughout the three phases （7 minutes）. Blood oxygen saturation and heart rate were measured during each phase. Our results show that blood oxygen saturation increased, heart rate decreased, and response time in the 1-back task decreased as the concentration and amount of administered oxygen increased. This shows that administration of sufficient oxygen for optimal cognitive functioning increases blood oxygen saturation and decreases heart rate.

Large Eddy Simulation of the Particle Coagulation in High Concentration Particle-Laden Planar Jet Flow

Particle coagulation by Brownian motion is an important but difficult research topic.When particle volume concentration is larger than 0.1%,the classic SMOLUCHOWSKI equation is not applicative anymore.The high concentration coagulation,with HEINE＇s correction,source terms for the Taylor-series expansion method of moments（TEMOM） are firstly driven in this paper.Ultra-fine particle（d0？100 mm） with initial volume fraction f？1% coagulation in a planar jet turbulence flow is simulated via the large eddy simulation（LES）.The instantaneous and time-averaged particle distributions and the high concentration enhancement are given out.The particle number concentration distribution results show that the coagulation is more intense comparing to dilute case in previous research,especially near the nozzle exit.After jet flow is fully developed,the effect is much more obvious at the region between vortexes.The time-averaged γ（the high concentration enhance factor） distributes sharply and symmetrically about the jet centerline at the upstream,but becomes broad and flat at downstream where the cross-stream averaged γ fluctuates drastically.As a new attempt,this paper shows Brownian coagulation with high concentration also can be calculated via TEMOM appropriately,and the coagulation at the region between vortexes is about 1.38 times intensive of the dilute result calculated by the classic Smoluchowski theory.

Hygrometry behavior during high-flow nasal oxygen therapy and non-invasive mechanical ventilation:A narrative review of bench to clinical studies

Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.

Diffusion Process of High Concentration Spikes in a Quasi-Homogeneous Turbulent Flow

When a mass spreads in a turbulent flow, areas with obviously high concentration of the mass compared with surrounding areas are formed by organized structures of turbulence. In this study, we extract the high concentration areas and investigate their diffusion process. For this purpose, a combination of Planar Laser Induced Fluorescence (PLIF) and Particle Image Velocimetry (PIV) techniques was employed to obtain simultaneously the two fields of the concentration of injected dye and of the velocity in a water turbulent channel flow. With focusing on a quasi-homogeneous turbulence in the channel central region, a series of PLIF and PIV images were acquired at several different downstream positions. We applied a conditional sampling technique to the PLIF images to extract the high concentration areas, or spikes, and calculated the conditional-averaged statistics of the extracted areas such as length scale, mean concentration, and turbulent diffusion coefficient. We found that the averaged length scale was constant with downstream distance from the diffusion source and was smaller than integral scale of the turbulent eddies. The spanwise distribution of the mean concentration was basically Gaussian, and the spanwise width of the spikes increased linearly with downstream distance from the diffusion source. Moreover, the turbulent diffusion coefficient was found to increase in proportion to the spanwise distance from the source. These results reveal aspects different from those of regular mass diffusion and let us conclude that the diffusion process of the spikes differs from that of regular mass diffusion.

Equilibrium between titanium ions and high-purity titanium electrorefining in a NaCl-KCl melt

TiClx （x=2.17） was prepared by using titanium sponge to reduce the concentration of TiCl4 in a NaCl-KCl melt under negative pressure. The as-prepared NaCl-KCl-TiClx melt was employed as the electrolyte, and two parallel crude titanium plates and one high-purity titanium plate were used as the anode and cathode, respectively. A series of electrochemical tests were performed to investigate the influence of electrolytic parameters on the current efficiency and quality of cathodic products. The results indicated that the quality of cathodic products was related to the current efficiency, which is significantly dependent on the current density and the initial concentration of titanium ions. The significance of this study is the attainment of high-purity titanium with a low oxygen content of 30× 10^-6.

Effects of oxygen enriched tent by a new oxygen concentration machine on blood oxygen saturation and heart rate in tibet

Many people who live in the low altitude areas are often suffered from hypoxia when they entered the high plateau. This problem may seriously influence the physical and mental state and work efficacy for the travelers and workers. Oxygen enrichment of a small space air at high altitude is considered as a simple way to provide lowlanders enriched oxygen for sleeping and resting, improving work efficiency, so we developed an oxygen concentration machine based on the technology of oxygen enrichment membrane. This paper tested 8 healthy male lowlanders (age 21.63±1.77 yr) who have never exposed to plateau performed an incremental exercise on cycle ergometer at sea-level in order to be used as sea-level controls. Two days later, the same subjects were taken to Lhasa (3700 m) by air and exposed to the plateau, performed the same exercise as they did at sea-level. The next day, all subjects were asked to enter the experimental tent which was enriched with oxygen (higher than 24%) by the oxygen concentration machine and sleep for 10 hours at night, then exposed to plateau and performed the same exercise twice at different time (2 hours and 10 hours after oxygen enrichment). During the tests, subjects must cycled continuously at 60 rpm beginning with a 3 min exercise intensity of 0 W followed by incremental increases of 25 W every 3 min until 150 W, pulse oxygen saturation (SpO2) and heart rate (HR) were recorded. After sleeping in an oxygen enrichment of tent air, 2 hours later, the subjects’ load capacity had no difference compared with control group, but significant difference than before (higher SpO2 and lower HR), which indicated that oxygen concentration machine is effective in increasing the oxygen concentration of the air for the tent and sleeping in the oxygen enrichment tent for l0 h might be effective in improving exercise performance during high-altitude hypoxia. At the same time, 10 hours later, when work-load exceeded 125 W, the same effects were also found. The results indicated the effects of oxygen enrichment of tent air could last a certain period of time.

Experimental studies on resistance characteristics of high concentration red mud in pipeline transport

Red mud will flow in paste form under high pressure during pipeline transport.It belongs to a two-phase flow of materials with high viscosity and a high concentration of non-sedimentation,homogeneous solid-liquids.In pipeline transport,its resistance char- acteristics will be influenced by such factors as grain size,velocity,concentration,density, grain composition and pipe diameter etc..With the independently developed small-sized tube-type pressure resistance test facility,studied the resistance characteristics of red mud concerning the three influencing factors,paste concentration,velocity and pipe diameter, which attract the most attention in projects.The fine grain size of the red mud is d_(50)= 13.02μm.According to the experimental results,the pressure loss in transport will in- crease along with the increase of velocity and will fall along with the increase of pipe di- ameter.A 1% difference in paste concentration will result in a 50%～100% difference in pipeline resistance loss.These experimental data is hoped to be direct guidance to the design of high concentration and viscous material pipeline transport system.

Simultaneous nitrogen and phosphorus removal under low dissolved oxygen conditions

A full-scale test was operated by using low dissolved oxygen activated sludge process to enhance biological nitrogen and phosphorus removal. When the influent concentrations of CODCr, TN and TP varied in a range of 352.9 mg/L-1338.2 mg/L, 34.4 mg/L-96.3 mg/L, and 2.21 mg/L-24.0 mg/L, the average removal efficiencies were 94.9%, 86.7% and 93.0%, respectively. During the test period of two months, effluent meas of CODCr,, BOD5, NH3-N, TN and TP were below 50 mg/L, 25 mg/L, 10 mg/L and 1.0 mg/L respectively. The low dissolved oxygen activated sludge process has a simple flow sheet, fewer facilities and high N and P removal efficiency. It is very convenient to retrofit the conventional activated sludge process with the above process.

Advanced Treatment of Wastewater and Slightly Deteriorated Raw Water by Biological Activated Carbon Method under Rich Oxygen Condition

Rich oxygen-biological activated carbon(RO-BAC)method developed from traditional BAC method is a sys-tem in which high pressure is applied to improve the oxy-gen concentration of the influent.Experiment withwastewater and the slightly deteriorated raw water showsthe system is an effective option for advanced treatmentof industry wastewater and pretreatment of slightly dete-riorated raw water.The experiment results and the in-fluential factors are discussed in this paper.

Energy Efficiency Analysis of Oxy-Fuel Circulating Fluidized Bed Combustion System with High Oxygen Concentration

The low net efficiency of oxy-fuel circulating fluidized bed(CFB)combustion is mainly due to the addition of air separation unit(ASU)and carbon dioxide compression and purification unit(CPU).High oxygen concentration is one of the effective methods to improve the net efficiency of oxy-fuel combustion technology in CFB.In this research,a series of calculation and simulation were carried out based on Aspen Plus platform to provide valuable information for further investigation on the CFB oxy-fuel combustion system with high oxygen concentration(40%,50%).A CFB oxy-fuel combustion system model with high oxygen concentration was established including ASU,CPU and CFB oxy-fuel combustion and heat exchange unit.Based on the simulation data,energy and exergy efficiency were analyzed to obtain the following results.The cross-sectional area of furnace and tail flue of 50%CFB oxy-fuel combustion boiler are 43%and 56%of the original size respectively,reducing the construction and investment cost effectively.With the increase of oxygen concentration,the net efficiency of power generation increased significantly,reaching 24.85%and increasing by 6.09%under the condition of 50%oxy-fuel combustion.The total exergy loss increases with the increase of oxygen concentration.In addition,the exergy loss of radiation heat transfer is far higher than convection heat transfer.

欧洲呼吸协会2022版《急性呼吸衰竭患者经鼻高流量氧疗临床实践指南》解读

欧洲呼吸协会于2022年发布了《急性呼吸衰竭患者经鼻高流量氧疗临床实践指南》,该指南旨在为急性低氧性呼吸衰竭、手术患者术后拔管、非手术患者拔管以及高碳酸血症型呼吸衰竭4种情境下的氧疗管理提供指导。涵盖了8个主题,下设相应的推荐意见。尽管该指南的制订方法规范严谨,但需要指出的是,现有的临床证据质量等级并不高,尚需更多研究来进一步支持这些推荐意见的有效性。尽管如此,这份指南仍可帮助急诊医护人员更好地开展急性呼吸衰竭患者的氧疗实践。

经鼻高流量鼻导管湿化氧疗联合氨溴索双途径给药对重症肺炎合并呼吸衰竭患者的疗效

目的分析经鼻高流量鼻导管湿化氧疗(high-flow nasal cannula,HFNC)联合氨溴索双途径给药对重症肺炎合并呼吸衰竭患者动脉血气指标、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、肺表面活性蛋白D(surfactant protein D,SP-D)水平的影响。方法选取收治的重症肺炎合并呼吸衰竭患者92例,用随机数字表法分为观察组和对照组,每组46例。对照组给予氨溴索双途径给药(氨溴索肺泡灌洗和氨溴索雾化)治疗,观察组在对照组治疗的基础上联合应用HFNC。2组均连续治疗7 d。比较2组临床相关指标和临床疗效,治疗前后动脉血气指标和血清hs-CRP、SP-D水平的变化,记录治疗期间2组不良反应的发生情况。结果治疗后,观察组机械通气时间、住院时间均短于对照组,再插管率低于对照组(P<0.05)。观察组的总有效率(89.13%)高于对照组(71.74%),P<0.05。观察组动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))均高于对照组(P<0.05),动脉血二氧化碳分压(PaCO_(2))、血清hs-CRP和SP-D均低于对照组(P<0.05)。治疗期间,2组患者均未出现严重不良反应。结论重症肺炎合并呼吸衰竭患者接受HFNC联合氨溴索双途径给药治疗,可有效改善患者的动脉血气指标,减轻炎性反应,提高治疗效果,促进患者病情恢复。

经鼻加温湿化高流量氧疗对重症肺炎患儿血气指标、MMP-9及TNF-α的影响

目的 探讨经鼻加温湿化高流量氧疗(HFNC)治疗小儿重症肺炎的疗效及对血气指标、基质金属蛋白酶9(MMP-9)、肿瘤坏死因子α(TNF-α)的影响。方法 选取2018年5月—2020年8月河北省人民医院收治的123例重症肺炎患儿作为研究对象,按照随机抽样法分为观察组(HFNC治疗,n=62)与对照组(面罩吸氧治疗,n=61)。对比两组临床症状、动脉血二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))、TNF-α、MMP-9、血氧饱和度/吸入氧浓度与呼吸频率的比值(ROX指数)。结果 观察组的退热时间、体征消失时间、咳嗽咳痰消失时间、住院时间分别为(5.21±1.02)d、(10.02±1.32)d、(7.41±0.96)d、(9.02±2.69)d,均短于对照组(t=5.688、10.332、10.253、2.180,P<0.05)。观察组治疗后2、6、12、24 h的ROX指数分别为(6.31±1.62)、(9.85±1.96)、(11.65±2.39)、(13.46±3.25),均高于对照组(t=2.467、3.380、4.251、4.902,P<0.05);治疗后,观察组的PaCO_(2)(35.69±5.21)mmHg低于对照组,而PaO_(2)(87.52±18.69)mmHg高于对照组(t=2.379、4.647,P<0.05);治疗后,观察组的MMP-9、TNF-α分别为(6.32±1.05)pg/mL、(10.40±1.30)pg/mL,低于对照组(t=13.425、13.060,P<0.05)。结论 HFNC用于重症肺炎患儿中具有显著效果,有利于改善患儿血气指标,降低MMP-9、TNF-α水平。

基于归因理论的护理干预在经鼻高流量氧疗患者中的应用效果

目的探讨基于归因理论的护理干预在经鼻高流量氧疗(HFNC)患者中的应用价值,以期为临床治疗提供参考。方法选取2021年2月-2023年5月于四川大学华西医院接受治疗的144例HFNC患者为研究对象。采用随机数字表法将患者分为观察组和对照组,每组72例。对照组患者给予常规护理干预,观察组患者在对照组基础上联合基于归因理论的护理干预。比较2组患者遵医情况及护理满意度;比较2组患者干预前后疾病感知问卷(BIPQ)、Borg疲劳量表、视觉类比呼吸困难法量表(VAS)、抑郁自评量表(SDS)及焦虑自评量表(SAS)评分。结果观察组患者总遵从率高于对照组,差异有统计学意义(P<0.05)。干预前,2组患者BIPQ中治疗控制、后果、情绪、持续时间、症状、关注、个人控制、疾病了解评分比较,差异无统计学意义(P>0.05)。干预后,2组患者BIPQ中治疗控制、后果、情绪、持续时间、症状、关注、个人控制、疾病了解评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P<0.05)。干预前,2组患者Borg疲劳量表及VAS评分比较,差异无统计学意义(P>0.05)。干预后,2组患者Borg疲劳量表评分均低于干预前,且观察组低于对照组;VAS评分高于干预前,且观察组高于对照组,差异均有统计学意义(P<0.05)。干预前,2组患者SAS、SDS评分比较,差异无统计学意义(P>0.05)。干预后,2组患者SAS、SDS评分均低于干预前,且观察组低于对照组,差异均具有统计学意义(P<0.05)。观察组患者护理总满意度高于对照组,差异有统计学意义(P<0.05)。结论基于归因理论的护理干预能有效强化患者的遵医行为,减轻患者的疾病感知压力,缓解患者的负面情绪,提高患者的护理满意度,值得临床推广应用。

无创通气间歇期经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重临床效果及对患者气管插管率、血气指标的影响

目的:分析无创通气(NIV)间歇期经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重(AECOPD)临床效果及对气管插管率、血气指标的影响。方法:回顾性收治的105例AECOPD患者资料,将患者分为对照组52例[接受无创通气(NIV)治疗与常规氧疗]和观察组53例(接受NIV联合HFNC治疗),比较两组患者临床指标、血气指标、治疗失败原因及不良反应。结果:观察组呼吸支持时间、NIV间歇歇息次数、NIV每日平均使用时间、ICU住院时间均短(小)于对照组(均P<0.05),两组气管插管率比较差异无统计学意义(P>0.05);治疗后两组动脉血氧分压(PaO_(2))比治疗前明显升高,动脉血二氧化碳分压(PaCO_(2))比治疗前明显降低(P<0.05),但两组治疗后PaO_(2)、PaCO_(2)水平比较差异无统计学意义(均P>0.05);观察组患者呼吸困难加重率、治疗不耐受率均低于对照组(均P<0.05),两组CO_(2)潴留加重率、低氧血症加重率比较差异无统计学意义(均P>0.05);观察组不良反应发生率显著低于对照组(P<0.05)。结论:NIV间歇期给予HFNC治疗AECOPD患者对气管插管率及血气指标的影响与常规氧疗差异不显著,但可改善患者其他临床指标,减少治疗失败情况及不良反应。

经鼻高流量湿化氧疗在慢性阻塞性肺疾病急性加重期患者的应用价值

目的探讨经鼻高流量湿化氧疗(HFNC)对慢性阻塞性肺疾病急性加重期(AECOPD)患者的疗效及适用条件。方法回顾性分析中山市小榄人民医院呼吸内科2021年1月~2022年12月收治并好转出院的60例AECOPD患者的临床资料,所有患者均在抗感染、止咳化痰、平喘等治疗的基础上,给予呼吸支持治疗。按照呼吸支持治疗方式不同分为HFNC组(30例)与无创正压通气(NPPV)组(30例)。比较两组患者生命体征(心率、呼吸)、血气分析[氧分压(PaO_(2))、氧合指数(PaO_(2)FiO_(2))]情况。根据年龄及PaO_(2)FiO_(2)分层,分析HFNC组患者血气分析指标的变化情况。结果治疗前,两组患者心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)组间比较,差异无统计学意义(P>0.05)。治疗后,两组患者心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)组间比较,差异无统计学意义(P>0.05);HFNC组治疗前后心率、PaO_(2)、PaO_(2)FiO_(2)比较[(85.47±13.21)次min vs.(97.67±22.62)次min、(95.92±27.33)mmHg vs.(80.3±19.02)mmHg、(321.23±78.73)mmHg vs.(278.40±67.21)mmHg],差异有统计学意义(P<0.05);NPPV组治疗前后心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)比较[(90.33±12.02)次min vs.(105.70±22.03)次min、(20.67±0.76)次min vs.(24.93±2.45)次min、(91.54±34.81)mmHg vs.(70.86±24.03)mmHg、(311.03±113.14)mmHg vs.(240.53±86.28)mmHg],差异有统计学意义(P<0.05)。根据年龄及PaO_(2)FiO_(2)分层,与治疗前比较,HFNC组患者年龄≥71岁、PaO_(2)FiO_(2)在201~300 mmHg之间的患者治疗后PaO_(2)、PaO_(2)FiO_(2)明显上升,差异有统计学意义(P<0.05)。结论HFNC及NPPV均可改善AECOPD患者的氧合功能,效果相当,可作为NPPV的备选方案。HFNC尤其适用于年龄71岁及以上、PaO_(2)FiO_(2)在201~300 mmHg的人群。