经鼻高流量氧疗在急性心力衰竭治疗中的临床应用  

Clinical application of transnasal high volume oxygen therapy in acute heart failure

作　　者：张珂[1] 田凤娥 刘景刚[1] 杨圣强[1] 杨文宝[1] Zhang Ke;Tian Fenge;Liu Jinggang;Yang Shengqiang;Yang Wenbao(Department of ICU,Huxi Hospital Affiliated to Jining Medical College ( Central Hospital of Shan County),Heze,Shandong 274300,China)

机构地区：[1]济宁医学院附属湖西医院单县中心医院重症医学科,山东省274300

出　　处：《中国基层医药》2019年第5期527-531,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山东省医药卫生科技发展计划(2015WS0467).

摘　　要：目的探讨经鼻高流量氧疗在急性心力衰竭患者中的临床应用价值。方法选取2016年1月至2018年1月济宁医学院附属湖西医院(单县中心医院)重症医学科收治的急性心力衰竭患者61例为研究对象,采用随机数字表法将患者分为对照组和治疗组,对照组31例,治疗组30例,两组患者均常规给予控制液体量、镇痛、强心、利尿、扩血管、抗血小板聚集、营养支持等治疗。对照组给予常规氧疗,治疗组给予经鼻高流量氧疗(NHF)。观察两组患者治疗开始前及治疗后12 h、24 h、48 h、72 h,各时间点左心室射血分数(LVEF)、氧合指数(PaO2/FiO2)、血乳酸(Lac)、血清中B型脑钠钛(BNP)浓度,以及7 d内无创机械通气及有创机械通气的应用率情况。结果治疗组与对照组比较,治疗后各时间点LVEF均增大[(35.58±3.64)%比(37.77±3.76)%,(37.87±3.58)%比(40.07±3.36)%,(44.94±3.19)%比(46.83±3.21)%,(47.55±3.45)%比(49.97±4.12)%,t=-2.308、-2.466、-2.316、-2.487,均P<0.05];治疗后各时间点PaO2/FiO2明显增高[(177.39±10.62)mmHg比(184.17±10.49)mmHg,(188.00±11.72)mmHg比(198.57±18.47)mmHg,(204.06±17.69)mmHg比(221.40±23.80)mmHg,(265.23±34.51)mmHg比(290.37±26.72)mmHg,t=-2.507、-2.678、-3.236、-3.174,均P<0.05];治疗后各时间点BNP明显下降[(2 462.90±288.00)ng/mL比(2 264.53±366.44)ng/mL,(1 646.61±377.19)ng/mL比(1 474.07±214.03)ng/mL,(991.94±242.95)ng/mL比(811.90±258.67)ng/mL,(653.77±147.671)ng/mL比(526.47±127.87)ng/mL,t=2.355、2.187、2.803、3.594,均P<0.05];Lac在治疗后12 h及24 h明显下降[(5.05±0.69)mmol/L比(4.55±0.80)mmol/L,(3.68±0.89)mmol/L比(3.13±0.77)mmol/L,t=2.610、2.601,均P<0.05],而48 h及72 h两组比较无明显统计学意义[(1.62±0.65)mmol/L比(1.53±0.65)mmol/L,(1.36±0.64)mmol/L比(1.26±0.46)mmol/L,均P>0.05];对照组与治疗组7 d内无创机械通气应用率差异有统计学意义[35.48%(11/31)比13.33%(4/30),χ^2=4.034,P<0.05];对照组与治疗组7 d内有创机械通气应用率[12.Objective To explore the clinical value of transnasal high volume oxygen therapy in the treatment of patients with acute heart failure. Methods From January 2016 to January 2018, 61 cases with acute heart failure in Huxi Hospital Affiliated to Jining Medical College were selected.The patients were randomly divided into control group and treatment group according to the digital table, 31 cases in the control group and 30 cases in the treatment group.The two groups were routinely given control of fluid volume, analgesia, strong heart, diuresis, vasodilator, anti-platelet aggregation, camp support and so on.The control group was given conventional oxygen therapy, and the treatment group was treated with high flow oxygen through nose.Before treatment and 12h, 24h, 48h, 72h after treatment, the left ventricular ejection fraction (LVEF), oxygen index (PaO2/FiO2), serum lactic acid (Lac), B type sodium and titanium (BNP) in serum, and the application rate of non-invasive mechanical ventilation and invasive mechanical ventilation in 7d were observed in the two groups. Results Compared with the control group, the LVEF of the treatment group in each time point increased[(35.58±3.64)% vs.(37.77±3.76)%,(37.87±3.58)% vs.(40.07±3.36)%,(44.94±3.19)% vs.(46.83±3.21)%,(47.55±3.45%)% vs.(40.07±3.36%)%, t=-2.308,-2.466,-2.316,-2.487, all P<0.05]. The PaO2/FiO2 of the treatment group increased significantly at each time point after treatment[(177.39±10.62)mmHg vs.(184.17±10.49)mmHg,(188.00±11.72)mmHg vs.(198.57±18.47)mmHg,(204.06±17.69)mmHg vs.(221.40±23.80)mmHg,(265.23±34.51)mmHg vs.(290.37±26.72)mmHg, t=-2.507,-2.678,-3.236,-3.174, all P<0.05]. The BNP level of the treatment group decreased significantly at each time point after treatment[(2 462.90±288.00)ng/mL vs.(2 264.53±366.44)ng/mL,(1 646.61±377.19)ng/mL vs.(1 474.07±214.03)ng/mL,(991.94±242.95)ng/mL vs.(811.90±258.67)ng/mL,(653.77±147.671)ng/mL vs.(526.47±127.87)ng/mL, t=2.355, 2.187, 2.803, 3.594, all P<0.05]. The Lac level of the treatment group dec

关 键 词：氧吸入疗法 心输出量 乳酸 利钠肽 脑 高频通气 

分 类 号：R541.6[医药卫生—心血管疾病]