摘要
目的 :研究急性低氧呼吸衰竭患者经鼻高流量氧疗(high flow nasal cannula, HFNC)失败的相关危险因素,以早期识别HFNC失败的高危患者,从而避免延迟插管,为该类患者合理运用HFNC提供依据。方法:通过回顾性队列研究设计分析2016年1月至2018年6月入住我院重症医学科接受HFNC的急性低氧呼吸衰竭患者资料。根据HFNC后是否进行气管插管行有创机械通气治疗、死亡或放弃治疗,将患者分为治疗失败组和治疗成功组。比较2组患者性别、年龄、基础疾病、急性低氧呼吸衰竭原因、急性生理学和慢性健康状况评价(acute physiology and chronic health evaluation,APACHE)Ⅱ评分、生命体征,血气分析[动脉血氧分压(partial pressure of oxygen,PaO2)/吸入气氧浓度(fraction of inspire oxygen,FiO2)],是否应用血管活性药物(去甲肾上腺素、多巴胺、肾上腺素、多巴酚丁胺中任意1种或以上)、无创正压通气等,并比较2组患者运用HFNC后2、12、24、48 h以及插管前生命体征变化,动脉血气变化,重症监护病房(intensive care unit,ICU)住院时间、ICU 28 d病死率。结果:共45例患者纳入研究。其中治疗成功32例(71%),治疗失败13例(29%)。2组患者年龄、性别、APACHEⅡ评分、病死率、HFNC应用时间、初始PaO2/FiO2、是否应用血管活性药物、是否交替应用无创正压通气差异均无统计学意义(P>0.05)。2组患者应用HFNC后2、12、24、48 h的动脉血气变化差异均无统计学意义(P>0.05)。单因素分析显示,肺内原因[优势比(odds ratio,OR)=0.688,95%置信区间(confidence interval,CI):0.544~0.868, P=0.022]、初始PaO2/FiO2<100 mmHg (1 mmHg=0.133 kPa)(OR=6.000,95%CI:1.323~27.219, P=0.014)、初始流量>55 L/min(OR=0.208,95%CI:0.053~0.823, P=0.020)是HFNC治疗失败的危险因素。多因素分析显示,初始PaO2/FiO2<100 mmHg (OR=5.429,95%CI:1.059~27.833, P=0.043)是HFNC治疗失败的独立危险因素。结论 :初始PaO2/FiO2<100 mmHg为导致HFNC治
Objective To investigate the risk factors for high flow nasal cannula oxygen therapy(HFNC) failure in the patients with acute hypoxemic respiratory failure. Methods The patients who were admitted to Department of Critical Care Medicine, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine had acute hypoxemic respiratory failure and received HFNC treatment. The medical records of patients from January 2016 to June 2018 were collected and analyzed through retrospective cohort study. The patients were divided into treatment failure and success group according to whether they received intubation and treatment of invasive mechanical ventilation, were dead or do-not-resuscitation after HFNC. The data in medical records [gender, age, underlying disease, cause of acute hypoxemic respiratory failure, acute physiology and chronic health evaluation(APACHE) Ⅱ, vital sign, the ratio of partial pressure of oxygen(PaO2)/fraction of inspire oxygen(FiO2), using one or more vasoactive medicine or not using(norepinephrine, epinephrine,dopamine, dobutamine), applying noninvasive positive pressure ventilation(NIPPV) were compared between the two groups.In addition, the vital signs of 2,12,24 48 h after HFNC and before intubation, the changes of arterial blood gas, intensive care unit(ICU) time and the mortality of 28 d in ICU were compared between the two groups. Results A total of45 patients were enrolled in this study, of which 32 patients were in HFNC success group and 13 patients were in HFNC failure group. The clinical characteristics including age, gender, APACHE Ⅱ, mortality, duration of HFNC, initial PaO2/FiO2, treatment with or without vasoactive medicine and NIPPV were comparable between two groups(P>0.05). Univariate analyses showed the pulmonary etiology [odds ratio(OR)=0.688, 95% confidence interval(CI):0.544-0.868, P=0.022)], initial PaO2/FiO2<100 mmHg(1 mmHg=0.133 kPa)(OR=6.000, 95%CI:1.323-27.219, P=0.014), initial HFNC flow rate >55 L/min(OR =0.208, 95%CI:0.053-0.823, P =0.020) were rela
作者
徐国芳
何德华
潘婷婷
王枫
瞿洪平
谭若铭
刘嘉琳
XU Guofang;HE Dehua;PAN Tingting;WANG Feng;QU Hongping;TAN Ruoming;LIU Jialin(Department of Respiratory,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《内科理论与实践》
2020年第6期386-390,共5页
Journal of Internal Medicine Concepts & Practice
基金
广慈卓越青年培养计划项目(项目编号:GCQN-2019-B14)。
