高流量氧疗与常规氧疗治疗急性心源性肺水肿的应用效果  

Comparative study of high-flow oxygen therapy versus conventional oxygen therapy for acute cardiogenic pulmonary edema

作　　者：次彩哲 邰炜彦[1] 耿小勇[1] 韩宇 张晓君 CI Caizhe;TAI Weiyan;GENG Xiaoyong(Department of Cardiovascular Medicine,the Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院心血管内科,石家庄市050051

出　　处：《河北医药》2024年第5期688-692,共5页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划(编号:20201042)。

摘　　要：目的探讨高氧流量和常规氧流量在急性心源性肺水肿中的应用效果。方法采用前瞻性随机对照性研究方法,选择2019年2月至2021年10月收治的62例急性心源性肺水肿合并低氧血症的患者,随机分成常规组32例和高流量氧疗组(HFNC组)30例,常规组给予常规氧疗,直至文氏面罩或鼻导管吸氧使FiO2达50%,目标保持SPO2为90%~96%。HFNC组采用Optiflow经鼻高流量加温加湿氧疗系统AIRVO 2型治疗设备进行高流量氧疗,吸气峰流速的高流量的加温(37℃)加湿(100%相对湿度)空氧混合气体,初始参数氧流量4~6 L/min(相当于FiO240%~50%),空氧混合气体流量60 L/min。根据目标SPO2每5分钟上调或下调HFNC 10%氧浓度。对比患者的呼吸参数和氧合指标以及患者舒适度情况。结果与常规组相比,氧疗后30 min、60 min,HFNC组的HR均降低(均P<0.01);同时HFNC组各时间点的SBP无明显变化(P>0.05);氧疗后60 min,HFNC组舒适性评分明显上升(P<0.01)。其他各参数24 h无创通气、24 h有创通气、7 d病死率组内与组间相比差异均无统计学意义(P>0.05)。结论高流量氧疗可以有效改善急性心源性肺水肿患者的低氧状态,与常规氧疗相比,改善缺氧状态更快、更显著,具有使用简单、快速、舒适性好等特点,值得推广使用。Objective To compare the effect of high-flow oxygen therapy versus conventional oxygen therapy for acute cardiogenic pulmonary edema.Methods It was a prospective randomized controlled study involving 62 patients with acute cardiogenic pulmonary edema complicated with hypoxemia from February 2019 to October 2021.They were randomly divided into routine group(n=32)and high-flow oxygen thercpy group(n=30).Patients in the routine group were given conventional oxygen therapy until the fraction of inspired oxygen(FiO 2)reached 50% by oxygen inhalation with a Venturi mask or nasal catheter,and the target oxygen saturation(SpO 2)maintained at 90%-96%.Patients in the high-flow oxygen thercpy group were treated with high-flow oxygen therapy using the Optiflow nasal high-flow warming and humidification oxygen therapy system(AIRVO 2 respiratory humidification therapeutic apparatus),which consistently deliverd a high-flow warmed(37℃)and humidified(relative humidity of 100%)air-oxygen mixture above the peak inspiratory flow,with an initial oxygen flow of 4-6L/min(equivalent to 40%-50% of FiO 2)and a flow of 60L/min.The oxygen concentration of high-flow nasal cannula(HFNC)was enhanced or reduced by 10%every 5 minutes according to the targeted SpO 2.Respiratory parameters,oxygenation index and patient comfort were compared.Results Compared with the routine group,the heart rate(HR)of the high-flow oxygen therapy group decreased at 30min and 60min after oxygen therapy(P<0.01).Meanwhile,there was no significant change in the systolic blood pressure(SBP)at each time point in the high-flow oxygen therapy group(P>0.05).The comfort score in patients receiving HFNC oxygen therapy increased significantly at 60 min(all P<0.01).There were no significant differences in the 24h non-invasive ventilation,24h invasive ventilation and 7-day mortality between groups and within groups(all P>0.05).Conclusion High-flow oxygen therapy can effectively improve the hypoxic state of patients with acute cardiogenic pulmonary edema.Compared with conventio

关 键 词：高氧流量 常规氧流量 肺水肿 急性 心源性 

分 类 号：R541.63[医药卫生—心血管疾病]