经鼻高流量氧疗与无创通气治疗老年晚期肺癌合并呼吸衰竭患者的效果比较  

Comparison of the effects of high-flow nasal cannula oxygen therapy and noninvasive ventilation in the treatment of elderly patients with advanced lung cancer with respiratory failure

作　　者：夏俊杰[1] 王娟[1] 邹兴雄 王金诚 黄玲[1] 邱宇[1] 弋可 王开绿[1] XIA Junjie;WANG Juan;ZOU Xingxiong;WANG Jincheng;HUANG Ling;QIU Yu;YI Ke;WANG Kailyu(Department of Respiratory and Critical Care Medicine,the Third Hospital of Mianyang·Sichuan Mental Health Center,Mianyang 621000,Sichuan,China;Department of Radiology,the Third Hospital of Mianyang·Sichuan Mental Health Center,Mianyang 621000,Sichuan,China;Department of Respiratory and Critical Care Medicine,Sichuan Science City Hospital,Mianyang 621000,Sichuan,China)

机构地区：[1]绵阳市第三人民医院·四川省精神卫生中心呼吸与危重症医学科,四川绵阳621000 [2]绵阳市第三人民医院·四川省精神卫生中心放射科,四川绵阳621000 [3]四川省科学城医院呼吸与危重症医学科,四川绵阳6210000

出　　处：《癌症进展》2021年第8期814-818,共5页Oncology Progress

基　　金：绵阳市第三人民医院院内课题(202009)。

摘　　要：目的比较经鼻高流量氧疗(HFNC)与无创通气(NIV)治疗老年晚期肺癌合并呼吸衰竭患者的效果。方法采用随机数字表法将60例老年晚期肺癌合并呼吸衰竭患者分为HFNC组和NIV组,每组30例,NIV组给予经口鼻面罩NIV治疗,HFNC组给予HFNC治疗。比较两组患者的呼吸指标[pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数]、循环指标(呼吸频率、心率)、肺功能指标[第一秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、FEV1/用力肺活量(FVC)]、炎性因子指标[白细胞介素-6(IL-6)、肺表面活性物质相关蛋白质-D(SP-D)]、改良英国医学研究理事会呼吸困难指数(mMRC)、气管插管率和治疗耐受情况、住院时间和住院费用。结果治疗后12 h、治疗后24 h及出院前,两组患者PaCO2水平、心率、呼吸频率均逐渐降低(P﹤0.05),pH值、PaO2、氧合指数均逐渐升高(P﹤0.05),且治疗后12 h,NIV组患者的心率高于HFNC组(P﹤0.05)。治疗后,两组患者FEV1%、FEV1/FVC均高于本组治疗前,IL-6、SP-D水平和mMRC评分均低于本组治疗前,且NIV组IL-6水平和mMRC评分均高于HFNC组,SP-D水平低于HFNC组,差异均有统计学意义(P﹤0.05)。两组患者气管插管率和治疗不耐受率比较,差异均无统计学意义(P﹥0.05)。HFNC组患者的平均住院费用低于NIV组患者,住院天数短于NIV组患者,差异均有统计学意义(P﹤0.05)。结论HFNC在改善老年晚期肺癌合并呼吸衰竭患者的呼吸指标、循环指标、肺功能方面于NIV疗效相似,可减轻患者的炎性反应、改善呼吸困难症状,且不良反应轻微,但接受HFNC治疗的患者住院时间短、花费低。Objective To compare the effects of acute high-flow nasal cannula oxygen therapy(HFNC)and non-invasive ventilation(NIV)in the treatment of elderly patients with advanced lung cancer with respiratory failure.Method Random number table method divided 60 elderly patients with advanced lung cancer with respiratory failure into HFNC group and NIV group,30 cases in each group.The NIV group was given oral-nasal mask NIV treatment,and the HFNC group was given HFNC treatment.The respiratory indexes[pH,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),oxygenation index],circulatory indexes(respiratory rate,heart rate),pulmonary function indexes[forced expiratory volume in first second(FEV1)of predicted value(FEV1%),FEV1/forced vital capacity(FVC)],inflammatory factors[interleukin-6(IL-6),pulmonary surfactant associated protein(SP-D)],modified British Medical Research Council(mMRC),tracheal intubation rate,treatment tolerance,length of stay and cost of hospitalization were compared between the two groups.Result 12 hours after treatment,24 hours after treatment and before discharge,PaCO2 level,heart rate and respiratory rate of the two groups were gradually decreased(P<0.05),pH,PaO2 and oxygenation index were gradually increased(P<0.05),and 12 hours after treatment,heart rate of NIV group was higher than that of HFNC group(P<0.05).After treatment,FEV1%,FEV1/FVC of the two groups were higher than before treatment,the levels of IL-6 and SP-D,mMRC scores of the two groups were lower than before treatment,the IL-6 levels and mMRC scores of NIV group were higher than those of HFNC group,SP-D levels were lower than HFNC group,the differences were statistically significant(P<0.05).There was no significant difference in the intubation rate and treatment intolerance rate between the two groups(P>0.05).The average hospitalization cost of HFNC group was lower than that of NIV group,and the length of stay was shorter than that of NIV group(P<0.05).Conclusion HFNC is similar to NIV in improving

关 键 词：肺癌 呼吸衰竭 经鼻高流量氧疗 无创通气 

分 类 号：R734.2[医药卫生—肿瘤]