经鼻高流量氧疗与无创辅助通气治疗心力衰竭低氧患者的疗效比较:一项回顾性队列研究  

Comparison of the efficacy of high flow nasal therapy and non-invasive ventilation in the treatment of hypoxic patients with heart failure:a retrospective cohort study

作　　者：胡杰 宗丹 陆建红[1] 姬晓伟[1] HU Jie;ZONG Dan;LU Jianhong;JI Xiaowei(Department of Critical Care Medicine,Huzhou Central Hospital,Huzhou 313000,China)

机构地区：[1]湖州市中心医院重症医学科,313000

出　　处：《浙江医学》2024年第12期1264-1269,共6页Zhejiang Medical Journal

摘　　要：目的比较经鼻高流量氧疗(HFNC)与无创辅助通气(NIV)治疗心力衰竭(简称心衰)低氧患者的疗效。方法从美国重症监护医学信息数据库获取2008年至2019年入住ICU的694例心衰患者的数据,根据住院期间使用HFNC或NIV情况,分为HFNC组459例和NIV组235例。比较两组患者人口基线、合并症、合并心脏疾病、实验室指标、生命体征指标、临床结局等差异。绘制Kaplan-Meier曲线,并使用log-rank检验比较两组患者28 d累积生存率。采用多因素logistic回归模型控制可能混杂因素,比较HFNC组和NIV组患者48 h内治疗失败率;采用多因素Cox回归模型控制混杂因素,比较两组患者28 d死亡率。根据氧合指数(OI)分为OI≥100亚组和OI<100亚组,亚组分析HFNC和NIV患者48 h内治疗失败率和28 d死亡率。结果两组患者体重、慢性阻塞性肺疾病及冠心病比例、pH、剩余碱、PaCO_(2)、OI、总住院时间、ICU住院时间及氧疗时间比较差异均有统计学意义(均P<0.05)。两组患者48 h内治疗失败率和28 d死亡率比较差异均无统计学意义(均P>0.05)。经多因素logistic回归模型控制混杂因素后,HFNC组和NIV组患者48 h内治疗失败率比较,差异无统计学意义(OR=0.895,95%CI:0.568~1.412,P=0.634)。经多因素Cox回归模型校正混杂因素后HFNC组和NIV组患者28 d死亡率比较,差异无统计学意义(HR=1.006,95%CI:0.685~1.479,P=0.975)。校正混杂因素后,亚组分析结果显示各亚组间HFNC和NIV患者48 h内治疗失败率及28 d死亡率比较,差异均无统计学意义(均P>0.05)。结论HFNC及NIV是纠正心衰患者低氧血症的两种不同氧疗方式,HFNC的治疗效果不逊于NIV,临床使用过程中可根据患者不同需求,选择不同氧疗方式。Objective To compare the efficacy of high flow nasal therapy(HFNC)with non-invasive ventilation(NIV)in hypoxic patients with heart failure(HF).Methods Data of 694 HF patients admitted to ICU between 2008 and 2019 were obtained from the US Multiparameter Intelligent Monitoring in Intensive CareⅣdatabase.According to the use of HFNC or NIV during hospitalization,the patients were divided into the HFNC group with 459 cases and the NIV group with 235 cases.The differences of population baseline,comorbidities,combined heart disease,laboratory indicators,vital signs indicators and clinical outcomes were compared between the two groups.Kaplan-Meier curve was drawn,and the 28-day cumulative survival rate between the two groups was compared by log-rank test.Multivariate logistic regression model was used to control possible confounding factors,and the treatment failure rate within 48 h was compared between HFNC group and NIV group.Multivariate Cox regression model was used to control confounding factors,and the 28-d mortality was compared between the two groups.According to the oxygenation index(OI),the patients were divided into OI≥100 subgroup and OI<100 subgroup.Subgroups were analyzed for the treatment failure within 48 h and 28-d mortality in patients with HFNC and NIV.Results There were significant differences in body weight,COPD,coronary artery disease,pH,base excess,PaCO_(2),OI,length of hospital stay,ICU stay,and oxygen therapy time between the two groups(all P<0.05).However,the treatment failure rate within 48 h and 28-d mortality were not significantly different between the two groups(both P>0.05).After adjusting for potential confounding factors using a multivariate logistic regression model,there was no statistically significant difference in the treatment failure rate within 48 h between the HFNC group and NIV group(OR=0.895,95%CI:0.568-1.412,P=0.634).Furthermore,following adjustment for confounders through a multivariate Cox regression model,there was no significant difference in 28-d mortality between

关 键 词：心力衰竭 经鼻高流量氧疗 无创辅助通气 48 h治疗失败率 28 d死亡率 

分 类 号：R541.6[医药卫生—心血管疾病]