高流量鼻导管对急性百草枯中毒患者早期呼吸困难的治疗作用  

Effect of high-flow nasal cannula oxygen therapy on early respiratory distress in patients with acute paraquat poisoning

作　　者：兰洪海 刘晓伟[1] 刘倩倩 刘志[1] 刘伟[1] Lan Honghai;Liu Xiaowei;Liu Qianqian;Liu Zhi;Liu Wei(Emergency Department,First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院急诊科,沈阳110001

出　　处：《中华急诊医学杂志》2020年第3期350-354,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(81571882,81772053)。

摘　　要：目的针对百草枯(paraquat,PQ)中毒早期存在呼吸困难的患者应用高流量鼻导管吸氧(high flow nasal cannulae,HFNC),评估此治疗措施对急性PQ中毒患者早期呼吸困难的改善情况。方法前瞻性研究,纳入2017年5月1日至2018年5月1日因急性PQ中毒就诊于中国医科大学附属第一医院急诊科的患者。纳入标准:急性PQ中毒伴呼吸困难的患者,并符合以下条件:呼吸困难伴呼吸频率(respiration rate,RR)>25次/min或二氧化碳分压(partial pressure of CO2,PCO2)<32 mmHg(1 mmHg=0.133 kPa)。记录HFNC应用前及应用后15 min、30 min及1、2、4、6、12、24 h的RR、血氧饱和度(pulse oxygen saturation,SPO2)、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP),记录应用前、应用后6 h、24 h的血气结果。比较患者应用HFNC前后的RR、SPO2、HR、MAP、PCO2、氧分压(partial pressure of O2,PO2)、pH以及动脉血乳酸(lactic acid,Lac)的改善情况。组间差异比较采用Mann-Whitney U秩和检验;计数资料比较采用卡方检验;以P<0.05为差异有统计学意义。结果共有50例患者被纳入本研究,经随访28 d,存活26例,死亡24例。两组患者性别、年龄等基本特征组间差异无统计学意义。患者自诉服毒量、入院首次尿PQ浓度定量、Lac、PaCO2组间差异有统计学意义(P<0.05),其余生化检查结果组间差异无统计学意义(P>0.05)。应用HFNC可以明显降低所有患者各时间点的RR和HR,应用后6 h的PaCO2明显升高,36 mmHg(34,38)mmHg vs 30 mmHg(27,32)mmHg,P<0.05。而MAP、SPO2、PO2、pH以及Lac在应用HFNC前后差异无统计学意义。进一步比较生存组与死亡组在应用HFNC前后的RR及HR变化,发现生存组在应用HFNC后RR和HR比死亡组降低的更为明显,生存组患者应用HFNC的最大流速明显低于死亡组,35 L/min(25,40)L/min vs 55 L/min(50,60)L/min,P<0.01。结论HFNC可以明显降低急性PQ中毒伴呼吸困难患者早期的RR和HR,通过降低患者自身耗氧量对中毒后Objective To evaluate the effect of high-flow nasal cannula(HFNC)oxygen on the early respiratory distress in patients with acute paraquat poisoning.Methods This prospective study included patients who were hospitalized in the Emergency Department of First Hospital of China Medical University diagnosed and were diagnosed with acute PQ poisoning from May 1,2017 to May 1,2018.Inclusion criteria:acute PQ poisoning patients with dyspnea,and meet the following conditions:dyspnea with RR>25 beats/min or PCO2<32 mmHg.The following information were recorded:RR,SpO2,HR and MAP before and 15 min,30 min,1 h,2 h,4 h,6 h,12 h and 24 h after HFNC application,as well as and arterial blood gas before and 6 h,24 h after HFNC application.The improvement of RR,SpO2,HR,MAP,PCO2,PO2,pH and Lac were compared before and after HFNC.Mann-Whitney U rank test and Chi-square test were used and a P<0.05 was regarded as statistically significant.Results A total of 50 patients were included in the study.After 28 days of follow-up,26 patients survived and 24 died.There was no difference between the two groups in gender and age.There were differences in PQ oral doses,urinal PQ concentration,Lac and PaCO2 between the two groups.HFNC significantly reduced the RR and HR of all patients at all time points,and PaCO2 was significantly increased at 6 h after application,36 mmHg(34,38)mmHg vs 30 mmHg(27,32)mmHg(P<0.05),while MAP,SpO2,PO2,and pH had no significant differences.RR and HR of the survival group were significantly lower than those of the nonsurvival group,as well as the maximum flow rate,35 L/min(25,40)L/min vs 55 L/min(50,60)L/min(P<0.01).Conclusions HFNC can significantly reduce the early respiratory frequency and heart rate of patients with acute PQ poisoning and improve dyspnea.Meanwhile,it can significantly reduce the patients'oxygen consumption and improve the relative or absolute hypoxic state of patients after poisoning.

关 键 词：百草枯 中毒 呼吸窘迫 高流量鼻导管吸氧 

分 类 号：R595.4[医药卫生—内科学]