经鼻高流量氧疗在脓毒血症相关急性呼吸窘迫综合征中的应用  

Application of Transnasal Hyperflow Oxygen Therapy in Sepsis Related Acute Respiratory Distress Syndrome

作　　者：常灿 郝俊令 汪霞 王欢 董俊英[1] CHANG Can;HAO Junling;WANG Xia;WANG Huan;DONG Junying(Critical ward,Department of Respiratory and Critical Care Medicine,Heze Municipal Hospital,Heze,Shandong Prov-ince,274000 China)

机构地区：[1]菏泽市立医院呼吸与危重症医学科重症病区,山东菏泽274000

出　　处：《中外医疗》2022年第30期13-16,共4页China & Foreign Medical Treatment

基　　金：菏泽市立医院科技发展计划项目(2021YN02)。

摘　　要：目的 研究经鼻高流量氧疗(highflow nasal cannula oxygen therapy, HFNC)在脓毒血症相关急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)中的应用。方法 随机选取2020年7月—2022年1月菏泽市立医院收治的脓毒血症相关轻中度ARDS患者100例为研究对象,随机分为HFNC组、无创性正压通气治疗组(对照组),每组50例。比较两组患者的呼吸频率、心率、氧合指数、气管插管有创机械通气率、重症医学科(ICU)住院时间、肺炎发病率、28 d病死率、鼻面部皮损、腹胀及压力性损伤发生率以及氧疗依从性情况。结果 与治疗前相比,两组患者的氧合指数、呼吸频率及心率情况经过治疗后均能得到改善,差异有统计学意义(P<0.05);两组患者的28 d病死率、肺炎发病率、ICU住院时间以及气管插管有创机械通气率比较,差异无统计学意义(P>0.05);HFNC组患者的鼻面部皮损发生率为4.00%,腹胀及压力性损伤发生率为0.00%,氧疗依从性为92.00%,与对照组相比,差异有统计学意义(χ^(2)=6.010、17.650、6.650、7.860,P<0.05)。结论 HFNC在脓毒血症相关ARDS的治疗中取得良好疗效,经鼻高流量氧疗可改善患者的氧合、呼吸及心率情况,鼻面部皮损、腹胀及压力性损伤等不良反应发生率更低,氧疗依从性更佳,但对ICU住院时间、气管插管有创机械通气率、28 d病死率及肺炎发病率无明显影响。Objective To study the application of high-flow nasal cannula oxygen therapy on patients with acute respiratory distress syndrome caused by Sepsis. Methods 100 patients with Sepsis complicated with mild to moderate acute respiratory distress syndrome(ARDS) who were admitted to Heze Municipal Hospital from July 2020 to January 2022were randomly selected, they were randomly divided into HFNC group and non-invasive positive pressure ventilation treatment group(control group), with 50 cases in each group. The respiratory rate, heart rate, oxygenation index, invasive mechanical ventilation rate of endotracheal intubation, length of stay in ICU, incidence rate of pneumonia, 28 day mortality, incidence of rhinofacial skin lesions, abdominal distention and pressure injury, and compliance with oxygen therapy were compared between the two groups. Results Compared with before treatment, the oxygenation, respiratory rate and heart rate of patients in the two groups can be improved after treatment, and the difference was statistically significant(P<0.05). there was no statistically significant difference in the 28 d mortality, incidence rate of pneumonia,length of stay in ICU and invasive mechanical ventilation rate of tracheal intubation between the two groups(P>0.05).the incidence of nasal and facial skin lesions in HFNC group was 4.00%, the incidence of abdominal distension and pressure injury was 0.00%, and the compliance of oxygen therapy was 92.00%, compared with the control group, the difference was statistically significant(χ^(2)=6.010, 17.650, 6.650, 7.860, P<0.05). Conclusion For patients with Sepsis complicated with mild to moderate ARDS, high-flow nasal cannula oxygen therapy can improve the respiratory, oxygenation index and heart rate. It reduced the incidence rate of skin lesion of nose and face, abdominal distension and pressure ulcer, the oxygen therapy compliance was better. But it had no obvious influence on ICU monitoring time, endotracheal intubation, 28 d mortality and pneumonia incidence.

关 键 词：经鼻高流量氧疗 脓毒血症 急性呼吸窘迫综合征 无创性正压通气 

分 类 号：R5[医药卫生—内科学]