Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

High-flow nasal cannula oxygen therapy and noninvasive ventilation for preventing extubation failure during weaning from mechanical ventilation assessed by lung ultrasound score: A single-center randomized study

BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.

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.

Prone position combined with high-flow nasal oxygen could benefit spontaneously breathing, severe COVID-19 patients:A case report

BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.

Efficacy of high-flow nasal cannula on acute exacerbation of chronic obstructive pulmonary disease: A meta-analysis

Objective:To systematically evaluate the efficacy and feasibility of high-flow nasal cannula(HFNC)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Systematic searches on PubMed,Web of Science,the Cochrane Library,Embase,CBM(Chinese Biomedicine Database),CNKI(China National Knowledge Infrastructure),Wanfang Database and VIP were performed for randomized controlled trials(RCTs)which explored the effects of HFNC on patients with AECOPD.The retrieval time was from the establishment of each database to July 2019.RevMan5.3 software was used for statistical analysis.Results:A total of 12 articles were included,involving 812 patients.The results showed that:(1)Compared with conventional oxygen therapy,HFNC could improve patients'arterial partial oxygen pressure(PaO2)(MD=12.70,95%CI(7.00,18.40),Z=4.37,P<0.0001),reduce partial arterial blood carbon dioxide(PaCO2)(MD=-10.99,95%CI(-14.42,-7.55),Z=6.26,P<0.00001)and reduce endotracheal intubation rate(OR=0.19,95%CI(0.04,0.93),Z=2.05,P=0.04),shorten the hospitalization time(SMD=-0.74,95%CI(-1.11,-0.37),Z=3.95,P<0.0001).(2)Compared with non-invasive positive pressure ventilation,it has fewer adverse reactions(OR=0.18,95%CI(0.09,0.35),Z=5.08,P<0.00001)and shorter hospital stay(SMD=-0.57,95%CI(-0.90,-0.23),Z=3.33,P=0.0009).Conclusion:HFNC can improve the patients’hypoxia symptoms and CO2 retention,reduce the rate of tracheal intubation,and alleviate adverse reactions.However,Limited by the quality and region of the included studies,more high-quality are needed to test it.

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.

高流量湿化氧疗联合N-乙酰半胱氨酸雾化吸入在老年慢性阻塞性肺病急性加重合并Ⅱ型呼吸衰竭中的临床应用

目的:探讨经鼻高流量湿化氧疗联合N-乙酰半胱氨酸雾化吸入在老年慢性阻塞性肺病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者中的临床应用效果。方法:选取2022年8月~2024年1月南京鼓楼医院集团宿迁医院徐州医科大学附属宿迁医院收治的90例符合入选标准的老年AECOPD伴Ⅱ型呼吸衰竭患者为研究对象,随机分为常规组、雾化组及高流量湿化氧疗(HFNC)组各30例。三组患者入院后均予以常规对症支持和抗感染治疗。雾化组在常规治疗基础上,联合N-乙酰半胱氨酸雾化吸入治疗;HFNC组在常规治疗联合N-乙酰半胱氨酸雾化吸入基础上,予以HFNC,三组的治疗周期均为7 d。对比三组患者治疗前后各项生命体征相关指标、肺通气功能指标、动脉血气指标、炎性反应指标、临床疗效、感染控制时间、住院时间及不良反应发生率,并对各组治疗后各项数据进行分析,以评价鼻高流量湿化氧疗联合N-乙酰半胱氨酸雾化吸入治疗应用于老年AECOPD合并Ⅱ型呼吸衰竭患者中的可行性与有效性。结果:治疗2 d后,雾化组和HFNC组动脉血氧分压(PaO_(2))较常规组明显改善,而心率(HR)、呼吸率(RR)和动脉血二氧化碳分压(PaCO_(2))较常规组有所下降,且HFNC组下降更为显著,差异有统计学意义(P<0.05);治疗7 d后,雾化组和HFNC组HR、RR、PaCO_(2)、白细胞介素(IL)-4、IL-6、C反应蛋白(CRP)较常规组有所下降,而PaO_(2)、第一秒用力呼气容积(FEV1)、第一秒用力呼气容积与用力肺活量的比值(FEV1/FVC)指标较常规组有所上升,且HFNC组改善更为显著,差异有统计学意义(P<0.05);治疗7 d后,HFNC组治疗效果明显优于常规组和雾化组,同时感染控制时间和住院时长均较其他两组缩短,差异有统计学意义(P<0.05);三组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:将HFNC联合N-乙酰半胱氨酸雾化吸入相结合的治疗方案,在治疗老年AECOPD合并Ⅱ型呼吸衰竭患者中展现了显著的临床优势。联合治疗不仅有效改善了患者的血气分析指标和肺功能,还显著降低了炎性反应水平,缩短住院时长,具有重要的临床应用价值。

经鼻高流量湿化氧疗在小儿先天性心脏病术后的应用研究

目的观察经鼻高流量湿化氧疗在小儿先天性心脏病术后的应用。方法选取2019年1月至2023年11月期间,本院小儿心脏病中心1岁以内充血型先天性心脏病术后患儿80例为研究对象,按术后撤机后不同无创通气支持方式分为经鼻高流量湿化给氧组(HFNC组),经鼻持续气道正压通气(nCPAP组),各40例。比较两组术后机械通气时间、ICU停留时间、血气指标、呼吸频率(RR)、二次插管率、拔管后肺不张、术后合并感染发生率。结果HFNC组机械通气时间、ICU停留时间短于nCPAP组(P<0.05);时点与组别交互作用对患儿PaCO_(2)、PaO_(2)/FiO_(2)、RR影响有统计学意义(P<0.05),进行单独效应分析,结果显示,两组拔管前PaCO_(2)、PaO_(2)/FiO_(2)、RR比较,差异无统计学意义(P>0.05);拔管后1 h、6 h、12 h、24 h、48 h,HFNC组与nCPAP组PaCO_(2)、PaO_(2)/FiO_(2)、RR比较差异有统计学意义(P<0.05);HFNC组二次插管率、并发症发生率较nCPAP组低(P<0.05)。结论经鼻高流量湿化氧疗可有效改善小儿先天性心脏病术后氧合指数及呼吸频率,避免二次插管,缩短ICU滞留时间,促进患儿康复进程。

经鼻高流量湿化氧疗在有创通气撤机中的应用研究

目的:经鼻高流量湿化氧疗在有创通气撤机中的应用研究。方法:选取2021年7月至2023年12月收治的60例有创通气撤机患者为研究对象,分为常规组30例、研究组30例(随机数字表法),常规组采用传统气泡式湿化鼻导管吸氧方式,研究组采用经鼻高流量湿化氧疗,对比两组24~48h再插管率、有创通气撤机成功率、ICU住院时间等指标。结果:研究组临床指标水平优于常规组(P<0.05);研究组24h重插管率、48h重插管率均较常规组低,有创通气撤机成功率较常规组高(P<0.05);两组pH比较无差异(P>0.05),研究组干预后PaO_(2)水平较常规组表达高,PaCO_(2)水平较常规组表达低(P<0.05);研究组干预后心率、呼吸频率均低于常规组(P<0.05)。结论:经鼻高流量湿化氧疗,可有效改善患者临床指标,降低重插管率,提高有创通气撤机成功率,进而改善患者气道状态,心率与呼吸频率,值得推广。

NCPAP序贯高流量鼻导管湿化氧疗治疗新生儿肺炎合并呼吸衰竭效果

目的:探究经鼻持续气道正压通气(NCPAP)序贯高流量鼻导管湿化氧疗(HHFNC)治疗新生儿肺炎合并呼吸衰竭(RF)效果。方法:选取2019年1月-2023年3月本院接受治疗的肺炎合并RF新生儿102例,随机分为常规组(NCPAP序贯常规鼻导管吸氧治疗)和观察组(NCPAP序贯HHFNC治疗)各51例,比较两组治疗后临床症状消失时间,治疗24 h后血气指标、炎症因子水平、免疫功能。结果:治疗后临床症状消失时间观察组短于常规组;治疗24 h后,两组血氧分压、氧合指数及pH水平均升高且观察组(76.36±7.28 mmHg、204.75±20.15mmHg、7.25±0.59)均高于常规组(72.57±7.05mmHg、193.07±19.47mmHg、6.93±0.51),呼吸频率(51.43±3.67次/min)低于常规组(53.82±4.16次/min),两组炎症因子及免疫球蛋白水平均降低,且观察组C反应蛋白(9.25±1.06 mg/L)、中性粒细胞与淋巴细胞比值(1.22±0.31)、降钙素原(1.17±0.31 ng/L)均低于常规组(10.84±1.27 mg/L、1.48±0.36、1.41±0.45 ng/L)(均P<0.05)。结论:NCPAP序贯HHFNC可缩短肺炎合并RF新生儿临床症状改善时间,调节患儿血气指标及免疫功能,减轻炎症反应。

纤维支气管镜灌洗联合经鼻高流量湿化氧疗对重症肺炎合并呼吸衰竭患者动脉血气、呼吸功能及炎性因子水平的影响

目的探讨重症肺炎合并呼吸衰竭患者应用纤维支气管镜灌洗联合经鼻高流量湿化氧疗(HFNC)对动脉血气、呼吸功能及炎性因子水平的影响。方法择取我院2021年9月至2023年9月期间116例重症肺炎合并呼吸衰竭患者为研究对象,以随机数表法均分为2组。基础组58例给予HFNC,研究组58例增加纤维支气管镜灌洗。对比两组患者临床疗效、动脉血气、呼吸功能、炎性因子水平。结果研究组总有效率高于基础组(P<0.05);研究组患者动脉血氧分压(PaO_(2))、血氧饱和度(SpO_(2))水平均高于基础组,动脉血二氧化碳分压(PaCO_(2))水平低于基础组;研究组患者最大吸气压实测与预测比值(MIP%)、最大呼气压实测与预测比值(MEP%)水平均高于基础组,气道阻力(AR)、气道峰压(PAP)水平均低于基础组(P<0.05);研究组患者肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-10(IL-10)水平均低于基础组(P<0.05)。结论纤维支气管镜灌洗联合(HFNC)能够有效改善重症肺炎合并呼吸衰竭患者动脉血气及呼吸功能,减轻炎症反应,提高疗效。

经鼻高流量湿化氧疗治疗急性心力衰竭合并呼吸衰竭患者的临床疗效研究

目的 探讨在急性心力衰竭(AHF)合并呼吸衰竭患者的治疗中实施经鼻高流量湿化氧疗(HFNC)干预的临床效果。方法 78例急性心力衰竭合并呼吸衰竭患者,随机分为对照组和观察组,每组39例。对照组患者在常规治疗的基础上实施低流量氧疗,观察组患者在常规治疗的基础上联合实施经鼻高流量湿化氧疗。对比两组患者治疗后1、24 h的有效率、血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))],治疗前后心率、呼吸频率与血清C反应蛋白(CRP)、B型脑钠肽(BNP)水平,气管插管率与1个月内死亡率。结果 观察组治疗后1、24 h的有效率分别为79.49%、97.44%,均高于对照组的51.28%、79.49%(P<0.05)。治疗后1、24 h,观察组患者的心率、呼吸频率分别为(105.47±3.36)、(23.42±2.36)次/min和(91.31±2.54)、(19.45±2.86)次/min,均低于对照组的(116.72±3.52)、(27.58±3.52)次/min和(96.30±3.52)、(22.61±4.01)次/min(P<0.05)。治疗后1、24 h,观察组患者的PaO_(2)分别为(89.94±1.54)、(93.94±2.70)mm Hg(1 mm Hg=0.133 kPa),均高于对照组的(84.19±2.27)、(89.86±1.53)mm Hg, PaCO_(2)分别为(40.84±4.32)、(35.84±2.37)mm Hg,均低于对照组的(45.84±3.56)、(44.62±1.38)mm Hg(P<0.05)。治疗后24 h,观察组患者血清CRP(28.42±4.52)mg/L、BNP(2342.92±24.59)pg/ml均低于对照组的(35.98±5.27)mg/L、(3876.65±34.19)pg/ml(P<0.05)。观察组气管插管率5.13%低于对照组的20.51%(P<0.05);两组1个月死亡率对比,差异无统计学意义(P>0.05)。结论 对于急性心力衰竭合并呼吸衰竭患者早期采用经鼻高流量湿化氧疗效果显著,可以降低患者气管插管率,改善患者心力衰竭症状,提高治疗效果。

芪参益气滴丸联合经鼻高流量湿化氧疗治疗老年心力衰竭的单中心临床对照研究

目的观察芪参益气滴丸联合经鼻高流量湿化氧疗对老年心力衰竭患者血气指标、生命体征以及心功能的影响。方法选择纽约心功能分级Ⅲ~Ⅳ级的左心衰竭患者45例,随机分为对照组25例和观察组20例,对照组应用常规抗心衰治疗联合经鼻高流量湿化治疗仪辅助通气,观察组在对照组基础上口服芪参益气滴丸。观察并比较两组患者的临床疗效以及不同时间点的血气指标、生命体征及心脏功能。结果对照组患者的有效率为44.00%(11/25),观察组患者的有效率为75.00%(15/20),与对照组比较,观察组的有效率明显升高(P<0.05)。治疗前,两组患者的各生命体征及血气指标水平均无明显差异(P>0.05)。在治疗24 h后,与对照组比较,观察组患者动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))、二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))以及酸碱度(pondus Hydrogenii,pH)等血气指标与平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼吸频率(respiratory rate,RR)等生命体征差异均无统计学意义(P>0.05);治疗72 h后,与对照组比较,观察组患者的PaO_(2)水平显著升高,而PaCO_(2)显著下降,差异具有统计学意义(P<0.05,P<0.01);但两组患者的pH值差异无统计学意义(P>0.05)。治疗72 h后,观察组患者的MAP、HR和RR水平相较于对照组均明显降低,差异具有统计学意义(P<0.05)。治疗完成后,相较于对照组,观察组患者的左心室舒张末期内径(left ventricular end diastolic dimension,LVDD)、左室收缩末期内径(left ventricular end systolic diameter,LVDS)水平均明显降低,而左室射血分数(left ventricular ejection fraction,LVEF)水平则明显升高(P<0.01)。两组患者的气管插管病例数和入住ICU病例数均差异无统计学意义(P>0.05),但相较于对照组,观察组患者的住院天数显著减少,差异具有统计学意义(P<0.05)。结论芪参益气滴丸联合经鼻高流量湿化氧疗治疗老年心力衰竭具有良好的临床疗效,在改善患者的心衰症状和血氧饱和度同时,通过进一步提高其心功能。

经鼻高流量湿化氧疗联合布地奈德、盐酸氨溴索治疗新生儿肺炎的效果及对TGF-β1、LPS水平的影响

目的探究经鼻高流量湿化氧疗联合布地奈德、盐酸氨溴索治疗新生儿肺炎的效果。方法选择2019年1月至2022年2月收治的92例新生儿肺炎患儿为研究对象,以随机数字表法将其分为对照组和观察组,各46例。对照组接受布地奈德联合盐酸氨溴索治疗,观察组在对照组基础上加施经鼻高流量湿化氧疗。比较两组的治疗效果。结果观察组的体温恢复时间、呼吸困难缓解时间、肺啰音消失时间及住院时间短于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的转化生长因子-β1(TGF-β1)、脂多糖(LPS)水平低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的降钙素原(PCT)、可溶性髓样细胞触发受体-1(sTREM-1)及核因子-κB(NF-κB)水平低于对照组,差异具有统计学意义(P<0.05)。结论经鼻高流量湿化氧疗联合布地奈德、盐酸氨溴索治疗新生儿肺炎的效果较好,可改善临床症状及炎症反应,调节TGF-β1、LPS水平,缩短住院时间,值得推广。

短期经鼻高流量加温加湿氧疗与无创呼吸机辅助通气在呼吸衰竭患者中的运用效果对比

目的研究分析短期高流量经鼻导管加温加湿氧疗(High Flow Heated Humidified Oxygen Therapy Via Nasal Catheter,HFNC)与无创呼吸机辅助通气在呼吸衰竭患者中的运用效果。方法随机选取2022年6月—2023年9月晋江市医院收治的50例呼吸衰竭患者为研究对象,以不同治疗方式分为两组,各25例,对照组予以无创呼吸机辅助通气,观察组予以短期HFNC治疗,比较两组不同治疗时间段的基础体征、动脉血气以及并发症发生率。结果治疗后,观察组心率、呼吸频率及平均动脉压均优于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组血氧分压值、血二氧化碳分压值与血氧饱和度值均优于对照组,差异有统计学意义(P均<0.05)。观察组并发症发生率(8.00%)低于对照组(32.00%),差异有统计学意义(χ^(2)=4.500,P=0.033)。结论短期HFNC用于呼吸衰竭患者的辅治,较无创呼吸机辅助通气更有助于改善患者的基础体征及动脉血气,减少并发症发生。

High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure and COVID-19-related respiratory failure

Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiological effects of high-flow oxygen counterbalance the physiological consequences of acute hypoxemic respiratory failure by lessening the deleterious effects of intense and prolonged inspiratory efforts generated by patients.Its simplicity of application for physicians and nurses and its comfort for patients are other arguments for its use in this setting.Although clinical studies have reported a decreased risk of intubation with high-flow oxygen compared with standard oxygen,its survival benefit is uncertain.A more precise definition of acute hypoxemic respiratory failure,including a classification of severity based on oxygenation levels,is needed to better compare the efficiencies of different non-invasive oxygenation support methods(standard oxygen,high-flow oxygen,and non-invasive ventilation).Additionally,the respective role of each non-invasive oxygenation support method needs to be established through further clinical trials in acute hypoxemic respiratory failure,especially in severe forms.

经鼻高流量湿化氧疗对急性左心衰竭急诊急救患者血气指标和心功能及脑钠肽水平的影响

目的探究经鼻高流量湿化氧疗(HFNC)治疗急性左心衰竭(ALVF)急诊急救患者的效果。方法选取2020年1月至2022年6月聊城市妇幼保健院收治的90例ALVF患者作为研究对象,采用随机数字表法分为对照组与研究组,每组45例。对照组采用常规氧疗,研究组采用HFNC治疗。比较两组血气分析指标[动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))及氧合指数(PaO_(2)/FiO_(2))]、生命体征[呼吸频率(RR)、心率(HR)及平均动脉压(MAP)]、心功能[左心室射血分数(LVEF)、每搏输出量(SV)]、脑钠肽(BNP)、舒适状况[舒适状况量表(GCQ)评分]、健康状况[健康状况调查简表(SF-36)评分]。结果治疗24 h后,研究组PaO_(2)、SaO_(2)及PaO_(2)/FiO_(2)均高于对照组,差异有统计学意义(P<0.05)。治疗24 h后,研究组RR、HR均慢于对照组,MAP低于对照组,差异有统计学意义(P<0.05)。治疗24 h后,研究组LVEF高于对照组,SV大于对照组,差异有统计学意义(P<0.05)。治疗6、12、24 h后,研究组BNP水平均低于对照组,差异有统计学意义(P<0.05)。治疗24 h后,研究组生理、心理、环境、社会文化评分均高于对照组,差异有统计学意义(P<0.05)。治疗24 h后,研究组生理功能、生理职能、精神健康、生命活力、躯体疼痛、社会功能、情感职能、总体健康评分均高于对照组,差异有统计学意义(P<0.05)。结论HFNC可有效改善ALVF患者氧合指数与心功能,降低BNP水平,提高其身心舒适度。

NIPPV与HFNC交替疗法对重症肺炎致呼吸衰竭患者动脉血气指标及炎症因子水平的影响

目的研究无创正压通气(NIPPV)与经鼻高流量湿化氧疗(HFNC)交替疗法对重症肺炎致呼吸衰竭患者动脉血气指标及炎症因子水平的影响。方法选取我院2021年4月至2022年4月收治的80例重症肺炎致呼吸衰竭患者为研究对象,根据治疗方法将其分为对照组(n=40)和观察组(n=40)。对照组行单一NIPPV治疗,观察组采用NIPPV与HFNC交替疗法。比较两组的治疗效果。结果治疗2 h后,两组的呼吸频率(RR)、心率(HR)及平均动脉压(MAP)均低于治疗前,且观察组低于对照组,差异具有统计学意义(P<0.05)。治疗2 h后,观察组的动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))高于对照组,差异具有统计学意义(P<0.05);治疗2 h后,两组的动脉血二氧化碳分压(PaCO_(2))比较,差异无统计学意义(P>0.05)。治疗1 d后,两组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)水平低于治疗前,且观察组低于对照组,差异具有统计学意义(P<0.05)。结论NIPPV与HFNC交替疗法在重症肺炎致呼吸衰竭患者急救中的应用效果显著,可改善血流动力学,提升血氧指标,减轻炎症反应。

经鼻高流量湿化氧疗对重症肺炎感染患者炎症反应的影响

目的:探讨重症肺炎感染患者应用经鼻高流量湿化氧疗对炎症反应的影响。方法:选取80例本院2022年9月至2023年9月期间收治的重症肺炎感染患者为研究对象。根据随机数字表法将患者分为对照组和研究组,每组各40例。对照组接受经鼻持续气道正压通气治疗;研究组接受经鼻高流量湿化氧疗。治疗7 d后,收集两组患者临床资料,并使用统计学软件处理数据,分析比较两组治疗前、治疗后7 d炎症因子、血气分析指标水平以及并发症的发生情况。结果:较之对照组,研究组治疗后的C反应蛋白(C-reactive protein,CRP)、白介素-6(Interleukin-6,IL-6)、降钙素原(Procalcitonin,PCT)等炎症因子水平均显著降低(P<0.05)。研究组治疗后的呼吸频率(Respiratory rate,RR)水平比对照组显著降低,氧分压(Partial pressure of oxygen,PaO_(2))、氧合指数(Oxygenation index,OI)水平均比对照组显著提高(P<0.05)。两组治疗期间的并发症发生率无显著差异(P>0.05)。结论:经鼻高流量湿化氧疗应用于重症肺炎感染治疗,能减轻患者炎症反应,改善其血气分析指标,且并不会增加并发症发生风险,安全性较好。

加温湿化经鼻高流量氧疗治疗小儿重症肺炎的临床效果分析

目的观察在小儿重症肺炎中实施加温湿化经鼻高流量氧疗的临床效果。方法选取2020年4月—2023年6月本院儿童重症监护室收治的110例小儿重症肺炎患儿为研究对象,依照治疗方式的不同分为对照组(经鼻导管吸氧)、观察组(加温湿化经鼻高流量氧疗),每组55例,比较两组治疗效果。结果治疗后,观察组呼吸频率以及心率均低于对照组;观察组HCO_(3)(碳酸氢根)、PaO_(2)(氧分压)高于对照组,PaCO_(2)(二氧化碳分压)低于对照组;呼吸困难缓解天数以及住院时间均短于对照组(P<0.05)。结论对小儿重症肺炎实行加温湿化经鼻高流量氧疗能够进一步提升疾病的治疗效果,提升患者的血氧饱和度,缩短呼吸困难的恢复时间,值得临床推广。