经鼻高流量氧疗在重症肺炎合并急性呼吸窘迫综合征患者中的应用研究  

Application of pernasal high-flow oxygen therapy in treatment of severe pneumonia complicating with acute respiratory distress syndrome

作　　者：俞春梅 朱保锋[1] 彭强 秦桂香 YU Chunmei;ZHU Baofeng;PENG Qiang;QIN Guixiang(Department of Emergency,the First People′s Hospital of Nantong City in Jiangsu Province,Nantong,Jiangsu,226001)

机构地区：[1]江苏省南通市第一人民医院急诊科,江苏南通226001

出　　处：《实用临床医药杂志》2021年第18期20-23,28,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省南通市科技计划项目(MS22020010)。

摘　　要：目的分析经鼻高流量氧疗(HFNC)在重症肺炎(SP)合并急性呼吸窘迫综合征(ARDS)患者中的应用效果。方法选取SP合并ARDS患者90例为研究对象,采用随机数字表法分为试验组47例和对照组43例。2组均给予抗感染、液体复苏、营养支持等对症治疗,对照组同时给予无创通气治疗,试验组同时给予HFNC。治疗1周,比较2组痰液黏稠度、血气指标、舒适度与耐受性、再次插管率及并发症等指标。结果试验组痰液Ⅰ度和Ⅱ度患者占比为95.74%,高于对照组的81.40%,差异有统计学意义(P<0.05)。试验组呼吸频率(RR)低于对照组,动脉血氧分压[p_(a)(O_(2))]、血氧饱和度(SaO_(2))、氧合指数[p_(a)(O_(2))/FiO_(2)]高于对照组,差异有统计学意义(P<0.05或P<0.01)。试验组舒适度、呼吸困难、耐受性评分低于对照组,差异有统计学意义(P<0.01或P<0.05)。试验组再次插管率、并发症总发生率分别为6.38%、8.51%,低于对照组的23.26%、25.58%,差异有统计学意义(P<0.05)。结论HFNC有助于改善SP合并ARDS患者的痰液黏稠度及血气指标,提高舒适度及耐受性,降低再次插管率及并发症发生率。Objective To analyze application effect of high-flow nasal cannula oxygen therapy(HFNC)in patients with severe pneumonia(SP)complicating with acute respiratory distress syndrome(ARDS).Methods A total of 90 SP patients with ARDS were selected as the study objects,and divided into experimental group(n=47)and control group(n=43)by random number table method.Both groups were given symptomatic treatment such as anti-infection,fluid resuscitation and nutritional support.The control group was treated with non-invasive ventilation,and the experimental group was treated with HFNC at the same time.After 1 week of treatment,sputum viscosity,blood gas index,comfort and tolerance,reintubation rate and complications were compared between the two groups.Results The proportions of patients with sputum Ⅰ degree and Ⅱ degree in the experimental group was 95.74%,which was significantly higher than 81.40%in the control group(P<0.05).Respiratory rate(RR)of the experimental group was significantly lower,arterial partial pressure of oxygen[p_(a)(O_(2))],oxygen saturation(SaO_(2))and oxygenation index[p_(a)(O_(2))/FiO_(2)]of the experimental group were significantly higher than those of the control group(P<0.05 or P<0.01).The scores of comfort,dyspnea and tolerance of the experimental group were significantly lower than those of the control group(P<0.01 or P<0.05).The reintubation rate and the total incidence of complications in the experimental group were 6.38%and 8.51%,respectively,which were significantly lower than 23.26%and 25.58%in the control group(P<0.05).Conclusion HFNC can improve sputum viscosity and blood gas indexes in SP patients with ARDS,improve comfort and tolerance,and reduce the rate of reintubation and complication.

关 键 词：重症肺炎 急性呼吸窘迫综合征 经鼻高流量氧疗 无创机械通气 

分 类 号：R473.5[医药卫生—护理学] R563[医药卫生—临床医学]