高流量鼻导管氧疗无效的早期预测因素分析  

Analysis of early predictive factors for invalidity of high flow nasal catheter oxygen therapy

作　　者：张明明 王艳[2] 朱慧[2] 张星 吕君 Zhang Mingming;Wang Yan;Zhu Hui;Zhang Xing;Lyu Jun(Department of Emergency and Critical Care Medicine,Shanghai First People′s Hospital,Shanghai 200080,China;Respiratory and Critical Care Medicine,Shanghai First People′s Hospital,Shanghai 200080,China)

机构地区：[1]上海市第一人民医院急危重症医学科,200080 [2]上海市第一人民医院呼吸与危重症医学科,200080

出　　处：《中国实用护理杂志》2020年第10期721-727,共7页Chinese Journal of Practical Nursing

基　　金：上海交通大学科技基金项目(JYH1605)。

摘　　要：目的高流量鼻导管(HFNC)氧疗是治疗成年人呼吸窘迫的一种新方法,本研究旨在探讨HFNC氧疗对呼吸窘迫患者无效的早期预测因素。方法选择2017年1月至2019年3月上海市第一人民医院呼吸与危重症医学科、急危重症医学科162例呼吸窘迫患者进行HFNC氧疗,在医疗电子病历中提取患者年龄、性别、体质量、病史、诊断、生命体征、血氧饱和度/吸入氧气浓度(SpO2/FiO2,SF)比值、改良呼吸窘迫评分(mRDAI)、HFNC氧疗持续时间、更换高级氧疗支持时间、不良反应等数据。结果共纳入有效样本154例,中位年龄55(IQR47~72)岁,其中急性细支气管炎患者59例占38.3%,细菌性肺炎患者64例占41.6%,非典型或病毒性肺炎患者31例占20.1%;HFNC氧疗有效组患者129例占83.8%,无效组患者25例占16.2%。HFNC氧疗无效组患者在入院时SF比值较低,pH值较低,呼吸末二氧化碳(PCO2)较高(P值为0.008、0.012、0.001);HFNC氧疗有效组患者第1小时呼吸频率、mRDAI评分和SF比值的改善明显(t值为1.732、9.783、37.591,P<0.05或0.01);HFNC氧疗开始后第1小时SF比值低于195(AUC 0.842,95%CI 0.743~0.942,P<0.01)是氧疗无效的临界值。结论当呼吸窘迫患者运用HFNC氧疗支持时,患者的初始指端SpO2较低、血气PCO2较高和SF比值小于195是HFNC氧疗失败的早期预测因素。Objective High-flow nasal cannula(HFNC)is a new method to treat adult respiratory distress.This study aims to explore the early predictors of the inefficiency of HFNC in patients with respiratory distress.Methods A total of 162 patients with respiratory distress were treated with HFNC oxygen therapy in the Department of Respiratory and Critical Care Medicine,Emergency and Critical Care Medicine.The age,sex,weight,history,diagnosis,vital signs,blood oxygen saturation/inhaled oxygen concentration(SpO2/FiO2,SF)ratio,and modified respiratory distress score(mRDAI),duration of HFNC oxygen therapy,replacement of advanced oxygen therapy support time,adverse reactions and other data were extracted from the medical electronic medical records.Results A total of 154 valid samples were included,with a median age of 55(inter-quartile range 47-72),including 59 patients(38.3%)with acute bronchiolitis,64 patients(41.6%)with bacterial pneumonia,31 patients(20.1%)with atypical or viral pneumonia;129 patients(83.8%)with effective HFNC oxygen therapy and 25 patients(16.2%)with ineffective HFNC oxygen therapy.SF ratio in ineffective HFNC oxygen therapy patients at admission was lower,pH value was lower,partial pressure of carbon dioxide was higher(P values were 0.008,0.012,0.001).RR,mRDAI score and SF ratio in the first hour of effective HFNC oxygen therapy patients improved significantly(t values were 1.732,9.783,37.591,P<0.05 or 0.01).SF ratio in the first hour of HFNC was lower than 195(area under curve 0.842,95%CI 0.743-0.942,P<0.01).It was the critical value for the ineffectiveness of oxygen therapy.Conclusions When patients with respiratory distress are supported by HFNC oxygen therapy,the lower initial fingertip oxygen saturation,higher blood gas arterial partial pressure of carbon dioxide and lower SF ratio are the early predictors of failure of HFNC oxygen therapy.

关 键 词：呼吸窘迫 高流量氧疗 SpO2/FiO2(SF)比值 预测因素 

分 类 号：R563[医药卫生—呼吸系统]