HFNC辅助治疗支气管扩张症合并感染的临床疗效分析  

Clinical efficacy of high-flow nasal cannula oxygen therapy in treatment of bronchiectasis with infection

作　　者：房颖 卜小宁[2] 宋建奇 王娜 王涛 宏文智 FANG Ying;BU Xiaoning;SONG Jianqi;WANG Na;WANG Tao;HONG Wenzhi(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,北京100020

出　　处：《中国急救复苏与灾害医学杂志》2023年第2期211-215,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：首都卫生发展科研专项(编号:首发2018-2-1062)。

摘　　要：目的对比经鼻高流量湿化氧疗(HFNC)辅助治疗支气管扩张症(支扩)合并感染与常规疗法的临床疗效,探讨HFNC在支扩合并感染患者中的应用价值。方法选择2019年1月—2021年12月北京市大兴区中西医结合医院收治的支扩合并感染患者80例,随机分为试验组和对照组。对照组给予常规方法治疗,试验组给予常规疗法+HFNC治疗。比较两组基础资料:年龄、性别、体质量指数(BMI)、铜绿假单胞菌定植(PA定植)、入院时记录支扩严重程度指数(BSI)、FACED评分[F:FEV1;A:age;C:PA定植;E:extension(胸部CT上显示所浸润的叶数);D:呼吸困难指数(dyspnoea mMRC score)]。比较两组患者入院时及出院前下列指标:降钙素原(PCT),C-反应蛋白(CRP)、用力肺活量(FVC)、最大呼气流量(PEF)、一秒用力呼气容积(FEV1)、动脉血pH值(pH值)、动脉血二氧化碳分压(PaCO_(2))。氧合指数[PaO2/FiO2:(PaO2),(FiO2)]。比较两组患者插管率、28 d死亡率、住院日(d)、住院费用(元)。对比试验组与对照组氧疗相关不良事件发生率:管路冷凝水、噪音、面部损伤。结果性别、年龄、BMI、BSI、PA定植、E-FACED评分、pH、PaCO_(2)、P/F、PCT、CRP、FVC、FEV1、PEF对比,差异无统计学意义(P>0.05)。在治疗效果指标当中,两组患者PH值差异无统计学意义(P>0.05)。试验组PaCO_(2)低于对照组[(38.6±7.3)mmHg vs(40.0±8.3)mmHg,P<0.001],氧合指数高于对照组[(451.0±120.4)%vs(444.6±118.5)%,P=0.010]。试验组感染指标PCT、CRP均较对照组低(P<0.05)。试验组肺通气指标:FVC、FEV1、PEF均高于对照组(P<0.05)。试验组插管率及28 d死亡率与对照组比较差异无统计学意义(P>0.05)。但试验组比对照组住院日更短[(13.0±5.2)d vs(16.3±8.7)d,P=0.041],住院费用少[(161113.8±5821.5)元vs(28050.5±8610.3)元,P=0.035]。多因素分析显示,住院天数和分组是影响住院费用的因子。结论在支扩合并感染患者中,HFNC+常规治疗与常规治疗相Objective To investigate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)as adjuvant treatment of bronchiectasis complicated with infection.Methods 80 patients with bronchiectasis combined with infection were randomLy divided into 2 equal groups:control group undergoing conventional treatment,and experimental group receiving HFNC treatment in addition.Basic data,such as age,gender,body mass index(BMI);colonization by Pseudomonas aeruginosa(PA);bronchiectasis severity index(BSI),FACED score[forced expiratory volume in one second(FEV1);age,chronic colonisation,extension,dyspnoea index]were collected and compared.The following indicators:procalcitonin(PCT),C-reactive protein(CRP),forced vital capacity(FV),peak expiratory flow(PEF),FEV1,pH of arterial blood,and partial pressure of carbon dioxide(PaCO_(2))of arterial blood were compared between the two groups at admission and before discharge.The intubation rate,28-day mortality rate,length of hospitalization,and hospitalization expenses,incidence rate of adverse events related to oxygen therapy(pipeline condensation,noise,and facial injury)was compared too.Results There were no significant differences in most of the basic data between the 2 groups of patients:gender,age,BMI,BSI,colonization by PA,FACED score,and pH value.The PaCO_(2)value of the experimental group was lower than that of the control group[(38.6±7.3)mmHg vs(40.0±8.3)mmHg,P<0.000],and the oxygenation index was significantly higher than that of the control group[(451±120.4)vs(444.6±118.5),P=0.010].The infection indexes(PCT and CRP)of the experimental group were both significantly lower than those of the control group(P<0.05).The lung ventilation indexes of the experimental group(FVC,FEV1and PEF)were all significantly higher than those of the control group(P<0.05).There was no significant difference in intubation rate and 28-day mortality in the experimental group(P>0.05).Compared with the control group,the experimental group had shorter hospital stay[(13.0±5.2)d vs(16.3±8.7)d,P

关 键 词：支气管扩张症合并感染 HFNC 临床疗效 

分 类 号：R825.6[医药卫生—临床医学]