HFNC治疗Ⅱ型呼吸衰竭患者的安全性分析  

The Safety Index Analysis of HFNC on the TypeⅡRespiratory Failure Patients

作　　者：宋建奇 房颖 王涛 吕维 李琳 卜小宁[2] 姜纯国[2] 冯晓凯 SONG Jianqi;FANG Ying;WANG Tao;LV Wei;LI Lin;BU Xiaoning;JIANG Chunguo;FENG Xiaokai(Beijing Daxing District Integrated Traditional Chinese Medicine Hospital,Beijing 100076,China)

机构地区：[1]北京市大兴区中西医结合医院,北京100076 [2]首都医科大学附属北京朝阳医院,北京100002

出　　处：《中国急救复苏与灾害医学杂志》2021年第6期636-640,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2018年度首都卫生发展科研专项(编号:2018-2)。

摘　　要：目的探讨HFNC治疗Ⅱ型呼吸衰竭患者的安全性。方法选取2018年1月-2019年12月收住北京市大兴区中西医结合医院急诊科、呼吸科、ICU病房的88名Ⅱ型呼吸衰竭患者,随机分为HFNC组、NIV组对比两组患者入院时基础资料、治疗结局、以及氧疗时间(h/d)、护理干预(次/d)、舒适评分、呼吸困难评分、鼻面部破损、住院时间(d)。结果HFNC组与NIV组患者基础资料:性别、年龄、BMI、疾病构成(包括COPD、支气管扩张、支气管哮喘、OSA,其他:比如胸廓畸形、脊柱畸形、截瘫等)、APACHE II评分、患者基础脉血气分析(pH、PaCO_(2)、PaO_(2)/FiO_(2))、心率(HR)、呼吸频率(RR)、平均动脉压差异无统计学意义。治疗结局指标:HFNC组治疗失败率小于NIV组(20.9%vs.28.9%,P=0.035),差异有统计学意义;HFNC组氧疗方式切换率小于NIV组(11.6%vs.20%,P=0.014),差异有统计学意义。HFNC组与NIV组相比插管率(9.3%vs.8.9%,P=0.351)、28d病死率(11.6%vs.13.3%,P=0.853),差异无统计学意义。HFNC组与NIV组比:平均治疗时间更长(8 vs.4,P=0.016);护理干预次数少(4 vs.7,P=0.060);舒适评分更高(6 VS 5.5,P=0.039);面部破损比例更低(2.3%vs 11.1%,P=0.027),以上指标差异有统计学意义。HFNC组与NIV组比:呼吸困难评分(3vs.2,P=0.136)及住院时间(14vs.l3,P=0.245),差异无统计学意义。结论对于Ⅱ型呼吸衰竭患者,HFNC与NIV比较,安全性指标比如:治疗失败率、插管率、28 d病死率、住院时长无明显差异;而患者舒适性、面部破损比例、氧疗时长、护理干预次数具有明显优势。Objective The paper aims to explore the safety of HFNC(high-flow nasal cannula oxygen therapy)on the TypeⅡrespiratory failure patients.Methods 88 typeⅡRespiratory failure patients sampled and randomLy divided in-to treatment group(HFNC group)and control group(NIV group).These sampled 88 typeⅡrespiratory failure patients are received between January 2018 and December 2019,in emergency department,respiratory unit,and ICU of the Integrated Traditional Chinese and Western Hospital in Da Xing District,Bei Jing.By comparing the two group patients,index on basic information,treatment outcome,oxygen inhaling time(h/d),Airway care interventions(time/day),comfort score,dyspnea score,n(%)nasal facial shin breakdown,length of stay in hospital,etc.,the author tries to find out the safety of the HFNC on the typeⅡrespiratory failure patients.Results There is no significant difference between the two groups on the index of the basic information of patients:gender,age,BMI,disease institution(including COPD:chronic obstructive pulmonary disease;bronchi ectasi;bronchial asthma;OSA:Obstructive sleep apnea;chest deformity;spinal deformity;paralys/paraplegia,etc.)APACHEⅡ(Acute Physiology and Chronic Health EvaluationⅡ),the basic arterial carbon dioxide analysis(pH,PaCO_(2),PaO_(2)/FiO_(2):partial pressure of arterial oxygen/fraction of inspiration oxygen),heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP).There is a significant difference on the treatment outcome index between the two groups:the treatment failure rate of the HFNC group is lower than that of the NIV group(HFNC:20.9%vs.NIV:28.9%,P=0.035).Oxygen treatment switching rate of the HFNC group is also lower than that of HIV group(HFNC:11.6%vs.NIV:20%,P=0.014).There is no significant difference on the index of invasive ventilation(HFNC:9.3%vs.NIV:8.9%,P=0.351),and 28-day mortality(HFNC:11.6%vs.NIV:13.3%,P=0.853)between the HFNC group and the HIV group.There is no difference between the HFNC group and the HIV group on the following index(HFNC vs HIV):dur

关 键 词：HFNC NIV Ⅱ型呼吸衰竭 安全性 

分 类 号：R563.9[医药卫生—呼吸系统]