[1]赵海云,彭司淼,欧尽南,等. 高流量湿化氧疗与无创正压通气治疗Ⅰ型呼吸衰竭效果比较[J].中国医学物理学杂志,2019,36(9):1077-1081.[doi:DOI:10.3969/j.issn.1005-202X.2019.09.016]
 ZHAO Haiyun,PENG Simiao,OU Jinnan,et al. Therapeutic effects of high-flow nasal cannula oxygen therapy versus non-invasive positive pressure ventilation in patients with type I respiratory failure[J].Chinese Journal of Medical Physics,2019,36(9):1077-1081.[doi:DOI:10.3969/j.issn.1005-202X.2019.09.016]
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 高流量湿化氧疗与无创正压通气治疗Ⅰ型呼吸衰竭效果比较()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
36卷
期数:
2019年第9期
页码:
1077-1081
栏目:
医学生物物理
出版日期:
2019-09-25

文章信息/Info

Title:
 Therapeutic effects of high-flow nasal cannula oxygen therapy versus non-invasive positive pressure ventilation in patients with type I respiratory failure
文章编号:
1005-202X(2019)09-1077-05
作者:
 赵海云彭司淼欧尽南李乐之
 中南大学湘雅二医院呼吸与危重症医学科, 湖南 长沙 410011
Author(s):
 ZHAO Haiyun PENG Simiao OU Jin’nan LI Lezhi
 Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha 410011, China
关键词:
 高流量湿化氧疗无创正压通气呼吸衰竭呼吸频率氧合指数吞咽功能
Keywords:
 Keywords: high flow nasal cannula oxygen therapy non-invasive positive pressure ventilation respiratory failure respiratory rate oxygenation index swallowing function
分类号:
R563.8
DOI:
DOI:10.3969/j.issn.1005-202X.2019.09.016
文献标志码:
A
摘要:
 目的:比较高流量湿化氧疗(HFNC)与无创正压通气(NPPV)治疗Ⅰ型呼吸衰竭患者的临床效果。方法:选取2016年4月至2018年6月在中南大学湘雅二医院接受治疗的160例Ⅰ型呼吸衰竭患者,按照随机数字法分为NPPV组与HFNC组,每组80例。分析两组患者在住院期间不带呼吸机的时间、28 d内行气管插管例数、30 d死亡率、总住院时间,同时监测患者0~48 h呼吸频率、氧合指数变化,以及疼痛、腹胀、吞咽功能、营养支持途径情况。结果:HFNC组患者吞咽功能洼田饮水实验分级明显优于NPPV组(P<0.05)。HFNC组28 d内行气管插管例数与30 d死亡率明显低于NPPV组(P<0.05),总住院时间明显短于NPPV组(P<0.05),而两组不带呼吸机的时间比较无统计学意义(P>0.05)。HFNC组与NPPV组在营养支持途径(完全经口进食、可经口进食、肠内/外营养、完全肠外营养)情况比较,无统计学意义(P>0.05),HFNC组腹胀发生率为5.50%,明显低于NPPV组的22.50%(P<0.05)。两组患者呼吸频率随着治疗时间延长逐渐减低,在不同时间点(6、24、48 h)的呼吸频率明显小于治疗0 h(P<0.05);氧合指数随着治疗时间延长逐渐上升,在不同时间点(6、24、48 h)的氧合指数明显大于治疗0 h(P<0.05);同时HFNC组在不同时间点(6、24 h)的呼吸频率明显低于NPPV组(P<0.05),而两组在不同时间点(6、24、48 h)的氧合指数比较无统计学意义(P>0.05)。结论:HFNC治疗Ⅰ型呼吸衰竭患者较NPPV具有更低的腹胀发生率,且对吞咽功能影响更小,28 d内行气管插管例数更少,30 d死亡率更低,同时呼吸频率与氧合指数均明显改善,具有较高的临床应用价值。
Abstract:
 Abstract: Objective To compare the clinical effects of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) in patients with type I respiratory failure. Methods A total of 160 patients with type I respiratory failure who were treated in the Second Xiangya Hospital of Central South University from April 2016 to June 2018 were enrolled in the study and randomly divided into NPPV group and HFNC group, with 80 patients in each group. Duration of no ventilator during hospitalization, tracheal intubation within 28 days, 30-day mortality and total hospital stay were analyzed between two groups. Moreover, the respiratory rate and oxygenation index at different treatment time points (from 0 to 48 h), and pain, abdominal distension, swallowing function, nutritional support routes in two groups were monitored. Results The results of water swallow test showed that the swallowing function of HFNC group was significantly better than that of NPPV group (P<0.05). The number of patients treated with tracheal intubation within 28 days and 30-day mortality in HFNC group were significantly lower than those in NPPV group (P<0.05), and the total hospital stay was significantly shorter than that in NPPV group (P<0.05), while the duration of no ventilator were similar in two groups (P>0.05). There was no statistically significant difference between HFNC group and NPPV group in nutritional support route (total oral feeding, oral feeding, enteral/parenteral nutrition, total parenteral nutrition) (P>0.05). The incidence of abdominal distension was 5.50% in HFNC group, significantly lower than 22.50% in NPPV group (P<0.05). The respiratory rate of two groups decreased gradually with the prolongation of treatment time, and at different treatment time points (6, 24, 48 h), the respiratory rate was significantly less than that at 0 h treatment (P<0.05). As the treatment time prolonged, the oxygenation index at different treatment time points (6, 24, 48 h) was significantly greater than that at 0 h treatment (P<0.05). Meanwhile, the respiratory rate of HFNC group at different treatment time points (6, 24, 48 h) was significantly lower than that of NPPV group (P<0.05), and there was no significant difference in the oxygenation index between two groups at different treatment time points (6, 24, 48 h) (P>0.05). Conclusion Compared with NPPV, HFNC in patients with type I respiratory failure has a lower incidence of abdominal distension, and less effect on swallowing function. The comparison of NPPV and HFNC also shows that after the treatment of HFNC, there are fewer cases of tracheal intubations in 28 days, lower 30-day mortality, and remarkably improved respiratory rate and oxygenation index. In conclusion, HFNC has high clinical application value.

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备注/Memo

备注/Memo:
 【收稿日期】2019-03-18
【基金项目】湖南省卫生健康委科研计划课题(C2019150)
【作者简介】赵海云,护师,E-mail: 1006108065@qq.com
【通信作者】彭司淼,硕士,主管护师,E-mail: vkdwwd@163.com
更新日期/Last Update: 2019-09-23