摘要
目的研究高流量氧疗(HFNC)对重症Ⅰ型呼吸衰竭患者动脉血气、呼吸力学及28 d病死率的影响,探讨其临床应用价值。方法将2015年6月至2018年6月成都市第三人民医院ICU收治的124例Ⅰ型呼吸衰竭患者随机均分为2组,各62例,NPPV组采用无创正压通气(NPPV)为呼吸支持手段,HFNC组则给予HCNC治疗,比较2组治疗后动脉血气、呼吸力学、心率血压、呼吸舒适度以及并发症和预后情况。结果治疗后,2组PaO2、PaCO2及PaO2/FiO2随时间逐渐升高,组内不同时间差异有统计学意义(P <0.05),且HFNC组治疗后2 h、4 h及6 h时PaO2及PaO2/FiO2高于NPPV组,差异有统计学意义(P <0.05);2组RR、Ptp-ei、△Ptp随时间逐渐降低,Ptp-ee随时间逐渐升高,组内不同时间比较差异有统计学意义(P <0.05),且HFNC组通气30 min和60 min时Ptp-ee高于NPPV组,△Ptp低于NPPV组,差异有统计学意义(P <0.05);2组HR及MAP均无明显变化(P> 0.05),且2组相同时间比较差异无统计学意义(P> 0.05);2组舒适度评分随时间逐渐降低,组内不同时间比较差异有统计学意义(P <0.05),且HFNC组治疗后24 h及48 h时舒适度评分高于NPPV组,差异有统计学意义(P <0.05);HFNC组并发症发生率、28 d气管插管率、28 d病死率及平均ICU住院时间均低于NPPV组,差异有统计学意义(P <0.05)。结论采用HFNC治疗Ⅰ型呼吸衰竭可有效改善肺通气和换气功能,提高PaO2及PaO2/FiO2水平,降低肺驱动压并改善患者呼吸舒适度,减少机械通气相关并发症发生。
Objective To study the effects of high-flow nasal cannula oxygen therapy(HFNC) on arterial blood gas, respiratory mechanics and 28-day mortality rate in patients with severe type Ⅰ respiratory failure, and to explore its clinical application value. Methods 124 cases of patients with type I respiratory failure admitted to ICU of our hospital from June 2015 to June 2018 were randomly and evenly divided into two groups, with 62 cases in each group. NPPV group was given non-invasive positive pressure ventilation(NPPV) as respiratory support, and HFNC group was given HFNC. The arterial blood gas, respiratory mechanics, hemodynamics, respiratory comfort, complications and prognosis were compared between the two groups after treatment. Results After treatment,the PaO2, PaCO2 and PaO2/FiO2 in the two groups were gradually increased with time, and the difference was statistically significant within groups at different times(P < 0.05), and the PaO2 and PaO2/FiO2 at 2 h, 4 h and 6 h after treatment in HFNC group were higher than those in NPPV group(P < 0.05). The RR, Ptp-ei and △Ptp were decreased gradually with time while the Ptp-ee was gradually increased with time(P < 0.05), and the Ptp-ee at 30 min and 60 min of ventilation in HFNC group was higher than that in NPPV group while the △Ptp was lower than that in NPPV group(P < 0.05). There were no significant changes in the HR and MAP in the two groups(P> 0.05), and there was no significant difference between the two groups at the same time(P > 0.05). The comfort scores in the two groups were gradually decreased with time, and the difference was statistically significant between the two groups at the same time(P < 0.05), and the comfort score in HFNC group at 24 h and 48 h after treatment was higher than that in NPPV group(P < 0.05). The incidence rate of complication, 28 d tracheal intubation rate, 28 d mortality rate and average ICU stay in HFNC group were lower than those in NPPV group(P < 0.05).Conclusions HFNC for type Ⅰ respiratory failure can effectively imp
作者
曾小英
张川
乐涛
江利东
王玺
叶丹
柯丽
张亦
ZENG Xiao-ying;ZHANG Chuan;LE Tao;JIANG Li-dong;WANG Xi;YE Dan;KE Li;ZHANG Yi(Dept.of Critical Care Medicine,Chengdu Third People’s Hospital,Chengdu Sichuan 610000,China)
出处
《昆明医科大学学报》
CAS
2019年第12期80-85,共6页
Journal of Kunming Medical University
基金
四川省科技厅科研基金资助项目[2016ZZ002(YCRF)]
关键词
型呼吸衰竭
高流量氧疗
动脉血气
呼吸力学
28d病死率
Type Ⅰ respiratory failure
High-flow nasal cannula oxygen therapy
Arterial blood gas
Respiratory mechanics
28d mortality rate
