经鼻高流量湿化氧疗治疗急性心力衰竭合并呼吸衰竭患者的临床疗效研究  

Study on clinical efficacy of heated humidified high-flow nasal cannulae oxygen therapy in patients with acute heart failure and respiratory failure

作　　者：曹昌强 刘忠凤[1] 胡兴丽[1] 杨菊 CAO Chang-qiang;LIU Zhong-feng;HU Xing-li(Department of Cardiovascular Medicine,Guizhou Aerospace Hospital,Zunyi 563000,China)

机构地区：[1]贵州航天医院心血管内科,563000

出　　处：《中国实用医药》2024年第21期44-47,共4页China Practical Medicine

基　　金：遵义市科技计划项目(项目编号:遵义科合HZ(2021)174号)。

摘　　要：目的 探讨在急性心力衰竭(AHF)合并呼吸衰竭患者的治疗中实施经鼻高流量湿化氧疗(HFNC)干预的临床效果。方法 78例急性心力衰竭合并呼吸衰竭患者,随机分为对照组和观察组,每组39例。对照组患者在常规治疗的基础上实施低流量氧疗,观察组患者在常规治疗的基础上联合实施经鼻高流量湿化氧疗。对比两组患者治疗后1、24 h的有效率、血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))],治疗前后心率、呼吸频率与血清C反应蛋白(CRP)、B型脑钠肽(BNP)水平,气管插管率与1个月内死亡率。结果 观察组治疗后1、24 h的有效率分别为79.49%、97.44%,均高于对照组的51.28%、79.49%(P<0.05)。治疗后1、24 h,观察组患者的心率、呼吸频率分别为(105.47±3.36)、(23.42±2.36)次/min和(91.31±2.54)、(19.45±2.86)次/min,均低于对照组的(116.72±3.52)、(27.58±3.52)次/min和(96.30±3.52)、(22.61±4.01)次/min(P<0.05)。治疗后1、24 h,观察组患者的PaO_(2)分别为(89.94±1.54)、(93.94±2.70)mm Hg(1 mm Hg=0.133 kPa),均高于对照组的(84.19±2.27)、(89.86±1.53)mm Hg, PaCO_(2)分别为(40.84±4.32)、(35.84±2.37)mm Hg,均低于对照组的(45.84±3.56)、(44.62±1.38)mm Hg(P<0.05)。治疗后24 h,观察组患者血清CRP(28.42±4.52)mg/L、BNP(2342.92±24.59)pg/ml均低于对照组的(35.98±5.27)mg/L、(3876.65±34.19)pg/ml(P<0.05)。观察组气管插管率5.13%低于对照组的20.51%(P<0.05);两组1个月死亡率对比,差异无统计学意义(P>0.05)。结论 对于急性心力衰竭合并呼吸衰竭患者早期采用经鼻高流量湿化氧疗效果显著,可以降低患者气管插管率,改善患者心力衰竭症状,提高治疗效果。Objective To explore the clinical effect of heated humidified high flow-nasal cannulae oxygen therapy(HFNC)in patients with acute heart failure(AHF)and respiratory failure.Methods 78 patients with acute heart failure and respiratory failure were selected.The patients were randomly divided into a control group and an observation group,with 39 cases in each group.The control group received low-flow oxygen therapy on the basis of conventional treatment,and the observation group received heated humidified high flow-nasal cannulae oxygen therapy on the basis of conventional treatment.Patients in both groups were compared in terms of effective rate and blood gas indexes[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))]after 1 and 24 h of treatment,heart rate,respiratory rate,serum C-reactive protein(CRP),B-type natriuretic peptide(BNP)levels before and after treatment,tracheal intubation rate and mortality within 1 month after treatment.Results The effective rates of the observation group at 1 and 24 h after treatment were 79.49%and 97.44%,which were higher than 51.28%and 79.49%of the control group(P<0.05).At 1 and 24 h after treatment,the heart rate and respiratory rate of the observation group were(105.47±3.36)beats/min,(23.42±2.36)times/min and(91.31±2.54)beats/min,(19.45±2.86)times/min,which were lower than(116.72±3.52)beats/min,(27.58±3.52)times/min and(96.30±3.52)beats/min,(22.61±4.01)times/min in the control group(P<0.05).At 1 and 24 h after treatment,PaO_(2) were(89.94±1.54)and(93.94±2.70)mm Hg(1 mm Hg=0.133 kPa)in the observation group,which were higher than(84.19±2.27)and(89.86±1.53)mm Hg in the control group;PaCO_(2) were(40.84±4.32)and(35.84±2.37)mm Hg,which were lower than(45.84±3.56)and(44.62±1.38)mm Hg in the control group(P<0.05).At 24 h after treatment,the observation group had serum CRP of(28.42±4.52)mg/L and BNP of(2342.92±24.59)pg/ml,which were lower than(35.98±5.27)mg/L and(3876.65±34.19)pg/ml in the control group(P<0.05).The rat

关 键 词：经鼻高流量湿化氧疗 急性心力衰竭 呼吸衰竭 低氧血症 

分 类 号：R541.6[医药卫生—心血管疾病] R563.8[医药卫生—内科学]