经鼻高流量氧疗在重型COVID-19患者中的应用  

Application of high-flow nasal cannula oxygen therapy in patients with severe COVID-19

作　　者：李幼霞 邓西龙[1] 黄煌[1] 刘莹 雷春亮[1] 蔡卫平[1] 李粤平 蔡水江 范银强 刘勇进 梁桐 杜淑华 谢志伟[1] LI Youxia;DENG Xilong;HUANG Huang;LIU Ying;LEI Chunliang;CAI Weiping;LI Yueping;CAI Shuijiang;FAN Yinqiang;LIU Yongjin;LIANG Tong;DU Shuhua;XIE Zhiwei(Department of Critical Care Medicine,Guangzhou No.8 People's Hospital,Guangzhou,Guangdong 510060,China)

机构地区：[1]广州市第八人民医院重症医学科,广东广州510060

出　　处：《中国热带医学》2020年第8期751-754,759,共5页China Tropical Medicine

基　　金：广东省防治新型冠状病毒科技攻关专项(No.2020B111105001)。

摘　　要：目的探讨经鼻高流量氧疗(HFNC)在重型新型冠状病毒肺炎(COVID-19)患者中的应用价值。方法选择2020年1月—2020年2月在广州市第八人民医院HFNC治疗的成人重型COVID-19患者,根据HFNC成功与否将患者分为HFNC成功组与HFNC失败组,比较两组患者的临床资料、HFNC治疗时间,治疗前和治疗后2 h、48 h、72 h及停HFNC前或改有创前的呼吸、循环参数、肺超声评分(LUS)。结果41例HFNC治疗的重型COVID-19患者,男29例、女12例,年龄33~84岁,中位年龄59.93岁;平均治疗时间为6.71 d。27例(65.85%)经HFNC治疗后氧合改善、呼吸频率、心率明显好转,避免了气管插管有创通气,可成功撤机改鼻导管低流量吸氧;14例治疗失败。失败组急性生理学及慢性健康状况(APACHE)Ⅱ评分(19.86±6.70)高于成功组(7.82±3.49);成功组PaO2、SaO2、SPO2、氧合指数(PaO2/FiO2)较失败组有明显改善;HFNC治疗48 h,失败组RR、HR及PaO2/FiO2未见改善反而出现逐渐转差情况,差异有统计学意义(P<0.05)。停HFNC前,失败组的PaO2、SaO2、LUS、PaO2/FiO2均较HFNC前转差,差异有统计学意义(P<0.01)。结论HF⁃NC可作为重型COVID-19患者呼吸支持的手段,治疗过程中需密切观察患者相关指标,特别是HFNC治疗48 h时需注意患者的氧合指数、脉搏及呼吸频率,如氧合指数未见明显改善,需尽早改有创机械通气。Objective To investigate the clinical value of high-flow nasal cannula oxygen therapy(HFNC)in patients with severe coronavirus disease 2019(COVID-19).Methods Adult patients with severe COVID-19 who were treated with HFNC in Guangzhou Eighth People′s Hospital from January to February 2020 were selected.The clinical data,respiratory and circulatory parameters and lung ultrasound score(LUS)were collected to analyze the therapeutic characteristics of HFNC.Patients were divided into HFNC success group and HFNC failure group according to the success or failure of HFNC,breathing,circulation parameters,and LUS were compared in pre-treatment and 2,48,72 hours after treatment and before stopping HFNC or changing to invasive breathing.Results 41 patients with severe COVID-19 were treated with HFNC,29 males and 12 females,the age was 33-84 years old,the median age was 59.93 years old,the mean time of HFNC treatment was 6.7 days.Treatment failed in 14 patients:After treatment with HFNC,27 cases(65.85%)showed significant improvement in oxygenation,respiratory rate and heart rate,avoiding invasive endotracheal intubation,and successfully replacing the machine to the nasal catheter with low-flow oxygen inhalation.Acute physiological and chronic health conditions(APACHE)Ⅱscore[(19.86±6.70)points]in the failure group was higher than that[(7.82±3.49)points]in the success group;and PaO2,SaO2,SPO2 and PaO2/FIO2 in the success group were significantly higher than those in the failure group;HFNC treatment for 48 h:RR,HR and PaO2/FIO2 did not improve but gradually deteriorated in the failure group(P<0.05).Before stopping HFNC:PaO2,SaO2,Lus,PaO2/FIO2 in the failure group were significantly worse than those before HFNC(P<0.01).Conclusion HFNC can be used as inhalation support for patients with severe COVID-19.During the course of treatment,the relevant parameters of patients should be closely observed,especially the oxygenation index,pulse and breathing rate of patients should be paid attention to when HFNC is treated for 48 hours,i

关 键 词：经鼻高流量氧疗 新型冠状病毒肺炎 急性呼吸窘迫综合征 呼吸衰竭 

分 类 号：R563.1[医药卫生—呼吸系统]