无创通气与经鼻高流量氧疗治疗老年重症肺炎合并呼吸衰竭的临床分析  

Clinical effects of non-invasive ventilation and high-flow nasal cannula oxygen therapy in the treatment of elderly patients with severe pneumonia and respiratory failure

作　　者：余红[1] 张川[1] 乐涛[1] 王玺 张玉洁 钟金兰 Yu Hong;Zhang Chuan;Le Tao;Wang Xi;Zhang Yujie;Zhong Jinlan(Department of Critical Care Medicine,Third People's Hospital of Chengdu City,Chengdu,Sichuan,610000,P.R.China)

机构地区：[1]成都市第三人民医院重症医学科,四川成都610000

出　　处：《老年医学与保健》2022年第5期1075-1078,1092,共5页Geriatrics & Health Care

基　　金：四川省医学会重症医学(宜昌人福)科研项目(2016ZZ002)。

摘　　要：目的 探讨无创通气(NIV)与经鼻高流量氧疗(HFNC)在老年重症肺炎(SP)合并呼吸衰竭治疗中的应用效果。方法 采用随机数字表法,将成都市第三人民医院2017年8月—2021年4月收治的96例老年重症肺炎合并呼吸衰竭患者分为观察组(n=48)及对照组(n=48),对照组采用NIV治疗,观察组采用HFNC治疗。比较2组治疗前后肺功能、血气指标、 hs-CRP、 PARC/CCL18和并发症。结果 观察组治疗总有效率为87.50%优于对照组70.83%(P<0.05);观察组治疗后的SaO_(2)、 PaO_(2)、 FEV1、 MVV和FVC均高于对照组,PaCO_(2)、 hs-CRP和PARC/CCL18均低于对照组(P<0.001);观察组并发症发生率为8.33%低于对照组25.00%(P<0.05)。结论 HFNC治疗老年SP合并呼吸衰竭的疗效优于NIV,HFNC能促进肺功能恢复,调节血气指标,改善血清hs-CRP和PARC/CCL18水平,减少并发症。Objective To explore the effects of non-invasive ventilation(NIV) and high-flow nasal cannula oxygen therapy(HFNC) in the treatment of severe pneumonia(SP) complicated with respiratory failure in the elderly.Methods A total of 96 elderly patients with SP complicated with respiratory failure admitted to Third People’s Hospital of Chengdu City from August 2017 to April 2021 were divided into observation group(n=48) and control group(n=48) by random number table method.The control group was treated with NIV,and the observation group was treated with HFNC.The lung function,blood gas indexes,hs-CRP and PARC/CCL18 before and after treatment,and complications were compared between the two groups.Results The total effective rate of the observation group(87.50%) was higher than that of the control group(70.83%)(P<0.05).After treatment,SaO_(2),PaO_(2),FEV1,MVV and FVC in the observation group were higher than those in the control group,and PaCO_(2),hs-CRP and PARC/CCL18 were lower than those in the control group(P<0.001).The incidence of complications in the observation group was significantly lower than that in the control group(8.33% vs 25.00%)(P<0.05).Conclusion HFNC is superior to NIV in the treatment of elderly SP patients with respiratory failure.HFNC can promote lung function recovery,regulate blood gas indexes,improve serum levels of hs-CRP and PARC/CCL18,and reduce complication.

关 键 词：老年 重症肺炎 呼吸衰竭 无创通气 经鼻高流量氧疗 

分 类 号：R563.1[医药卫生—呼吸系统] R563.8[医药卫生—内科学]