经鼻高流量氧气湿化治疗改善老年患者呼吸衰竭的可行性研究  

A feasibility study on heated humidified high-fNm nasal cannula oxygen therapy for respiratory failure in elderly patients

作　　者：陈名珍[1] 杨珺楠[1] 李开来[1] 赵旭静[1] 薛安静 满姗姗 向平超[2] Chen Mingzhen;Yang Junnan;Li Kailai;Zhao Xujing;Xue Anjing;Man Shanshan;Xiang Pingchao(Department of Cadre's Ward,Peking University Shougang Hospital,Beijing 100144,China;Department of Respiratory&Critical Care Medicine,peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学首钢医院干部保健科,100144 [2]北京大学首钢医院呼吸与危重症医学科,100144

出　　处：《中华老年医学杂志》2020年第10期1165-1169,共5页Chinese Journal of Geriatrics

基　　金：北京大学首钢医院重点创新项目基金(SGYYZ201612)。

摘　　要：目的探讨经鼻高流量氧气湿化治疗(HFNC)老年患者呼吸衰竭的可行性。方法前瞻性研究,选择2016年12月至2019年3月在北京大学首钢医院住院的呼吸衰竭患者300例,HFNC组、传统氧疗(COT)组和无创正压通气(NPPV)组每组各100例。分别比较HFNC组与COT组,HFNC组与NPPV组患者氧疗后脉搏氧饱和度(SPO2)、氧合指数(OI)、心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、舒适度评分、出院率、气管插管率、转重症监护室(ICU)率、死亡率及转组率。结果 HFNC组氧疗30 min SPO2、1 h SPO2、6 h SPO2、出院前OI均高于COT组(t=-2.992、-2.884、-3.196、-2.060,P=0.003、0.005、0.002、0.048);两组患者出院前HR均低于氧疗前HR,COT组HR更低[(73.1±25.1)次/min比(75.1±25.9)次/min],但均在正常范围;HFNC组出院率显著高于COT组,转组率显著低于COT组(χ2=-1.969、-3.115,P=0.049、0.002);气管插管、转ICU及死亡率两组比较差异无统计学意义。HFNC组氧疗30 min SPO2、6 h SPO2均高于NPPV组(t=-2.026、-2.101,P=0.046、0.040),但出院前OI及SPO2两组比较差异无统计学意义;HFNC组和NPPV组患者出院前HR均低于氧疗前HR,组间比较差异无统计学意义;HFNC组与NPPV组死亡率、出院、气管插管、转ICU及转组率比较差异无统计学意义。HFNC组舒适度评分显著高于COT组及NPPV组(t=-3.758、-19.180,均P=0.000)。结论 HFNC是继COT及NPPV之后的新型氧疗设备,对于老年呼吸衰竭患者更具有优势。Objective To explore the feasibility of high-flow nasal cannula(HFNC)therapy for respiratory failure in elderly patients.Methods A total of 300 patients with respiratory failure admitted to Peking Univensity Shougang Hospital from December 2016 to March 2019 were enrolled in this prospective study.Patients were divided into three groups:the HFNC group,the conventional oxygen therapy(COT)group and the non invasive positive preSvSure ventilation(NPPV)group(n=100 in each group).Arterial oxygen saturation(SPO2).oxygen index(OI).heart rate(HR).respiratory rate(RR),mean arterial pressure(MAP),comfort level,discharge rate,tracheal intubation rate,rate of referral to ICU.mortality and rate of referral to another group after therapy were compared between the HFNC and COT groups and between the HFNC and NPPV groups.Results SPO2 after oxygen therapy for 30 minutes(t=-2.992,P=0.003),1 hour(r=-2.884,P=0.005)and 6 hours(t=-3.196,P=0.002)and OI before discharge(t=-2.060,P=0.048)were higher in the HFNC group than in the COT group.The HR in the above two groups was lower before discharge than before therapy,and the HR in the COT group wavs even lower(73.1±25.1 beat per minute vs.75.1±25.9 heat per minute),but both were within the normal range.The discharge rate was higher(χ^2=-1.969.P=0.049).while the rate of referral to another group was lower in the HFNC'group than in the COT group(χ^2=-3.115,P=0.002).There was no significant difference in the tracheal intubation rate,ICU transfer rate and mortality between the HFNC and COT groups.SPO:after oxygen therapy for 30 minutes(t=-2.026.P=0.046)and 6 hours(t=-2.101.P=0.040)were higher in the HFNC group than in the NPFV group,but there was no significant difference in OI and SPO2 between the two groups before discharge.The HR in both HFNC and NPPV groups was lower before discharge than before therapy,and there was no statistical difference between the two groups.The mortality,discharge rate,tracheal intubation rate,ICU transfer rate and rate of referral to another group had no signi

关 键 词：呼吸功能不全 无创正压通气 治疗 

分 类 号：R563.8[医药卫生—呼吸系统]