早期经鼻高流量氧疗在呼吸困难伴低氧血症的急诊患者中的应用:一项随机对照研究  

Initial application of high-flow nasal cannula for patients with acute dyspnea and hypoxemia in emergency department:A randomized controlled trial

作　　者：刘奇[1,2,3] 庞晓倩 李锋 兰超[1] 朱长举[3,4] 陈荣昌 Liu Qi;Pang Xiaoqian;Li Feng;Lan Chao;Zhu Changju;Chen Rongchang(Emergency Intensive Care Ward,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Laboratory of Translational Medicine Center,the First Affi liated Hospital of Zhengzhou University,Zhengzhou 450052,China;Key Laboratory of Emergency and Trauma Medicine of Henan Province,the First Affi liated Hospital of Zhengzhou University,Zhengzhou 450052,China;Emergency Department,the First Affi liated Hospital of Zhengzhou University,Zhengzhou 450052,China;Shenzhen Institute of Respiratory Diseases,Shenzhen People’s Hospital,Shenzhen 518020,China;State Key Laboratory of Respiratory Disease,Guangzhou Institute of Respiratory Diseases,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]郑州大学第一附属医院急诊重症监护病房,郑州450052 [2]郑州大学第一附属医院转化医学中心实验室,郑州450052 [3]郑州大学第一附属医院河南省急救与创伤医学重点实验室,郑州450052 [4]郑州大学第一附属医院急诊科,郑州450052 [5]深圳市人民医院/深圳市呼吸疾病研究所,深圳518020 [6]广州医科大学第一附属医院/广州呼吸疾病研究所、呼吸疾病国家重点实验室,广州510120

出　　处：《中华急诊医学杂志》2022年第3期356-363,共8页Chinese Journal of Emergency Medicine

基　　金：河南省卫生健康中青年学科带头人项目(HNSWJW-2020013);河南省卫生健康科技创新青年杰出人才项目(YXKC2020028)。

摘　　要：目的探讨在急诊科采用经鼻高流量氧疗(high-fl ow nasal cannula,HFNC)作为初始氧疗,与传统氧疗(conventional oxygen therapy,COT)相比是否可以降低呼吸困难伴低氧血症患者的气管插管率,并改善其他临床结局。方法自2019年10月1日至2020年9月30日在郑州大学第一附属医院进行前瞻性单中心随机对照研究。研究人员于急诊抢救室筛选出呼吸困难伴低氧血症的患者,并进行评估,纳入符合条件的急诊抢救室急性呼吸困难伴低氧血症患者210例,1∶1随机分配至HFNC组或COT组,分组后立即接受HFNC或COT治疗1 h。主要指标包括24 h内气管插管率,次要指标包括本次就诊总气管插管率、升级呼吸支持比率、患者治疗后去向、重症监护室时间和住院病死率等。计量资料根据数据分布采用独立样本t检验或Mann-Whitney U检验进行分析。计数资料采用卡方检验,并对60天生存率进行Kaplan-Meier分析。结果HFNC降低了就诊24 h内气管插管率(4.8%vs.14.3%,P=0.019),减少了患者被迫升级氧疗的比率(34.3%vs.53.3%,P=0.005),但不影响本次就诊的总气管插管率(χ2=0.463,P=0.509)。在急诊抢救室期间,HFNC使更多的患者达到目标指脉氧饱和度(90.5%vs.78.1%,P=0.02)、呼吸频率降至24次/min以下(68.6%vs.49.0%,P=0.004),但不影响住院时间,住院病死率和60 d存活率(P>0.05)。结论在急诊科初始应用HFNC可降低24 h内气管插管率,降低就诊过程中氧疗措施升级率,改善氧合,缓解呼吸困难。Objective To explore whether the adoption of high-fl ow nasal cannula(HFNC)as an initial oxygen therapy in emergency department(ED)could reduce the intubation rate and improve the clinical outcomes of patients with dyspnea and hypoxemia compared with conventional oxygen therapy(COT).Methods A perspective single-center randomized controlled trial was conducted in the First Affiliated Hospital of Zhengzhou University from October 1,2019 to September 30,2020.A total of 210 eligible patients with acute dyspnea and hypoxemia in ED were recruited and randomized(in 1:1)to receive HFNC or COT for 1 h immediately after the grouping.The primary outcome was the rate of intubation within 24 h.The secondary outcomes included total intubation rate,escalation of breathing support method,patients’disposition,length of ICU stay and hospital mortality.Continuous outcomes were analyzed by independent samples t test or Mann-Whitney U test according to the data distribution.Discontinuous outcomes were compared with the Chi-square test.Kaplan-Meier curve analysis was performed for 60-day survival.Results Finally,105 patients were recruited in each group.HFNC reduced the intubation rate within the first 24 h(4.8%vs.14.3%,P=0.019)and the rate of patients escalated to upgrade oxygen therapy(34.3%vs.53.3%,P=0.005),but did not affect the total intubation rate during the whole attendance(P=0.509).In ED,HFNC helped more patients to achieve the targeted saturation of pulse oxygen(90.5%vs.78.1%,P=0.02),and reduced respiratory rate(RR)to<25 breaths per min(68.6%vs.49.0%,P=0.004),but did not affect the length of hospital stay,hospital mortality and 60-day survival rate(P>0.05).Conclusions Initial application of HFNC in ED could reduce the intubation rate within 24 h,decrease the rate of escalation of oxygen therapy,improve oxygenation and relieve dyspnea.

关 键 词：经鼻高流量氧疗 呼吸困难 低氧血症 气管插管率 传统氧疗 

分 类 号：R563.8[医药卫生—呼吸系统]