经鼻高流量氧疗在急性左心衰竭中的疗效观察
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摘要
目的探讨经鼻高流量氧疗(HFNC)在急性左心衰竭中的治疗效果。方法选择2016年6月至2018年4月南京医科大学附属逸夫医院重症医学科收治的76例急性左心衰竭患者,按随机数字表法分为观察组和对照组,每组38例。对照组患者给予常规治疗,观察组患者在对照组基础上给予HFNC。观察治疗后2、6、12、24 h两组患者动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、动脉血氧饱和度(SaO_2)、心率及呼吸频率、左室射血分数(LVEF)、每搏输出量(SV)及N端脑利钠肽前体(NT-proBNP)等指标,比较两组患者的气管插管率、28 d病死率和ICU住院时间。结果两组急性左心衰竭患者各时间点PaO_2、PaCO_2、SaO_2、心率、呼吸频率、LVEF、SV及NT-proBNP比较,差异均有统计学意义(F=28.302、18.402、32.514、24.510、16.165、23.452、19.167、30.424,P均<0.05)。进一步两两比较发现,观察组患者各时间点PaO_2、SaO_2、LVEF及SV均显著高于对照组(P均<0.05),PaCO_2、心率、呼吸频率及NT-proBNP均显著低于对照组(P均<0.05);两组患者6、12、24 h PaO_2、PaCO_2、SaO_2、心率、呼吸频率、LVEF、SV及NT-proBNP与同组2 h比较,差异均有统计学意义(P均<0.05);两组患者12、24 h PaO_2、PaCO_2、SaO_2、心率、呼吸频率、LVEF、SV及NT-proBNP与同组6 h比较,差异均有统计学意义(P均<0.05)。观察组与对照组患者气管插管率[7.89%(3/38) vs. 23.68%(9/38),χ~2=3.982,P=0.026]、28 d病死率[2.63%(1/38) vs. 10.53%(4/38),χ2=4.307,P=0.011]及ICU住院时间[(6±3)d vs.(10±5)d,t=2.654,P=0.034]比较,差异均有统计学意义。结论 HFNC早期可显著改善急性左心衰竭患者的氧合功能和心功能指标,降低气管插管率及病死率,缩短ICU住院时间,改善预后。
Objective To study the therapeutic effect of high-flow nasal cannula oxygen therapy(HFNC) in patients with acute left heart failure. Methods From June 2016 to April2018, 76 patients with acute left heart failure in the Department of Intensive Care Medicine, Sir Run Run Hospital, Nanjing Medical University were divided into the observation group(n = 38)and control group(n = 38). Patients in the control group were given routine treatment and patients in the observation group were given HFNC on the basis of control group. The partial pressure of arterial oxygen(PaO_2), partial pressure of arterial carbon dioxide(PaCO_2), arterial oxygen saturation(SaO_2), heart rate, respiratory rate, left ventricular ejection fraction(LVEF),stroke volume(SV), and N-terminal pro-brain natriuretic peptide(NT-proBNP) of these two groups were observed at 2, 6, 12 and 24 hours after treatment. The tracheal intubation rate, 28-day mortality and ICU stay in the two groups were compared. Results There were significant differences in PaO_2, PaCO_2, SaO_2, heart rate, respiratory rate, LVEF, SV and NT-proBNP of patients with acute left heart failure between the two groups at each time point(F = 28.302,18.402, 32.514, 24.510, 16.165, 23.452, 19.167, 30.424; all P < 0.05). Further pairwise comparison showed that PaO_2, SaO_2, LVEF and SV in the observation group were significantly higher(all P < 0.05), and the PaCO_2, heart rate, respiratory rate and NT-proBNP were significantly lower than those in the control group at each time point(all P < 0.05). There were significant differences in the PaO_2, PaCO_2, SaO_2, heart rate, respiratory rate, LVEF, SV and NTproBNP of these two groups at 6 h, 12 h and 24 h compared with those in the same group at 2 h(all P < 0.05). There were significant differences in the PaO_2, PaCO_2, SaO_2, heart rate, respiratory rate, LVEF, SV and NT-proBNP of these two groups at 12 h and 24 h compared with those in the same group at 6 h(all P < 0.05). The tracheal intubation rate [7.89%(3/38) vs. 23.68%(9/38), χ~2=3.982, P = 0.026], 28 d mortality [2.63%(1/38) vs. 10.53%(4/38), χ2= 4.307, P = 0.011) and ICU stay [(6 ± 3) d vs.(10 ± 5) d, t = 2.654, P = 0.034] between the two groups were all statistically significantly different. Conclusion HFNC in the early stage can significantly improve oxygenation and cardiac functions, reduce tracheal intubation rate and mortality, shorten ICU stay, and improve prognosis in patients with acute left heart failure.
Objective To study the therapeutic effect of high-flow nasal cannula oxygen therapy(HFNC) in patients with acute left heart failure. Methods From June 2016 to April2018, 76 patients with acute left heart failure in the Department of Intensive Care Medicine, Sir Run Run Hospital, Nanjing Medical University were divided into the observation group(n = 38)and control group(n = 38). Patients in the control group were given routine treatment and patients in the observation group were given HFNC on the basis of control group. The partial pressure of arterial oxygen(PaO_2), partial pressure of arterial carbon dioxide(PaCO_2), arterial oxygen saturation(SaO_2), heart rate, respiratory rate, left ventricular ejection fraction(LVEF),stroke volume(SV), and N-terminal pro-brain natriuretic peptide(NT-proBNP) of these two groups were observed at 2, 6, 12 and 24 hours after treatment. The tracheal intubation rate, 28-day mortality and ICU stay in the two groups were compared. Results There were significant differences in PaO_2, PaCO_2, SaO_2, heart rate, respiratory rate, LVEF, SV and NT-proBNP of patients with acute left heart failure between the two groups at each time point(F = 28.302,18.402, 32.514, 24.510, 16.165, 23.452, 19.167, 30.424; all P < 0.05). Further pairwise comparison showed that PaO_2, SaO_2, LVEF and SV in the observation group were significantly higher(all P < 0.05), and the PaCO_2, heart rate, respiratory rate and NT-proBNP were significantly lower than those in the control group at each time point(all P < 0.05). There were significant differences in the PaO_2, PaCO_2, SaO_2, heart rate, respiratory rate, LVEF, SV and NTproBNP of these two groups at 6 h, 12 h and 24 h compared with those in the same group at 2 h(all P < 0.05). There were significant differences in the PaO_2, PaCO_2, SaO_2, heart rate, respiratory rate, LVEF, SV and NT-proBNP of these two groups at 12 h and 24 h compared with those in the same group at 6 h(all P < 0.05). The tracheal intubation rate [7.89%(3/38) vs. 23.68%(9/38), χ~2=3.982, P = 0.026], 28 d mortality [2.63%(1/38) vs. 10.53%(4/38), χ2= 4.307, P = 0.011) and ICU stay [(6 ± 3) d vs.(10 ± 5) d, t = 2.654, P = 0.034] between the two groups were all statistically significantly different. Conclusion HFNC in the early stage can significantly improve oxygenation and cardiac functions, reduce tracheal intubation rate and mortality, shorten ICU stay, and improve prognosis in patients with acute left heart failure.
引文
1张丹如,黄建芬,张丽萍,等.新型高流量湿化氧疗系统对气管切开非机械通气患儿下呼吸道感染的预防作用[J/CD].中华危重症医学杂志(电子版),2013,6(3):138-142.
2 Ou X,Hua Y,Liu J,et al.Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure:a meta-analysis of randomized controlled trials[J].CMAJ,2017,189(7):E260-E267.
3 Moreno FL,Hagan AD,Holmen JR,et al.Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function[J].Am J Cardiol,1984,53(4):579-585.
4 Nishimura M.For critically ill patients,is high-flow nasal cannula oxygen delivery a suitable alternative to mechanical ventilation?[J].Respir Care,2015,60(2):307-308.
5 Itagaki T,Okuda N,Tsunano Y,et al.Effect of highflow nasal cannula on thoraco-abdominal synchrony in adult critically ill patients[J].Respir Care,2014,59(1):70-74.
6 Papazian L,Corley A,Hess D,et al.Use of high-flow nasal cannula oxygenation in ICU adults:a narrative review[J].Intensive Care Med,2016,42(9):1336-1349.
7 Spoletini G,Alotaibi M,Blasi F,et al.Heated humidified high-flow nasal oxygen in adults:mechanisms of action and clinical implications[J].Chest,2015,148(1):253-261.
8 Barbier C,Loubières Y,Schmit C,et al.Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients[J].Intensive Care Med,2004,30(9):1740-1746.
9 Nishimura M.High-flow nasal cannula oxygen therapy in adults:physiological benefits,indication,clinical benefits,and adverse effects[J].Respir Care,2016,61(4):529-541.
10 Maggiore SM,Idone FA,Vaschetto R,et al.Nasal high-flow versus Venturi mask oxygen therapy after extubation.Effects on oxygenation,comfort,and clinical outcome[J].Am J Respir Crit Care Med,2014,190(3):282-288.
11 Stéphan F,Barrucand B,Petit P,et al.High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery:a randomized clinical trial[J].JAMA,2015,313(23):2331-2339.
12 Storgaard LH,Hockey HU,Laursen BS,et al.Longterm effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure[J].Int J Chron Obstruct Pulmon Dis,2018(13):1195-1205.
13 Hawkins S,Huston S,Campbell K,et al.High-flow,heated,humidified air via nasal cannula treats CPAP-intolerant children with obstructive sleep apnea[J].JClin Sleep Med,2017,13(8):981-989.
14 Roca O,Pérez-Terán P,Masclans JR,et al.Patients with New York Heart Association classⅢheart failure may benefit with high flow nasal cannula supportive therapy:high flow nasal cannula in heart failure[J].JCrit Care,2013,28(5):741-746.
15 CarrataláPerales JM,Llorens P,Brouzet B,et al.H-igh-Flow therapy via nasal cannula in acute heart failure[J].Rev Esp Cardiol,2011,64(8):723-725.
16么颖,余慕明,刘艳存,等.持续监测和控制人工气道气囊压力对机械通气患者呼吸机相关肺炎发生率影响的Meta分析[J/CD].中华危重症医学杂志(电子版),2016,9(6):389-393.
17张其霞,蔡晓丹,方振红,等.无镇静方案在综合ICU机械通气患者中的应用[J/CD].中华危重症医学杂志(电子版),2018,11(3):213-216.
18 Hernández G,Vaquero C,Colinas L,et al.Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients:a randomized clinical trial[J].JAMA,2016,316(15):1565-1574.
19 Hernández G,Vaquero C,Gonzalez P,et al.Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients:a randomized clinical trial[J].JAMA,2016,315(13):1354-1361.
20 Frat JP,Thille AW,Mercat A,et al.High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure[J].N Engl J Med,2015,372(23):2185-2196.
21 Roca O,Riera J,Torres F,et al.High-flow oxygen therapy in acute respiratory failure[J].Respir Care,2010,55(4):408-413.
22 Kang BJ,Koh Y,Lim CM,et al.Failure of high-flow nasal cannula therapy may delay intubation and increase mortality[J].Intensive Care Med,2015,41(4):623-632.
2 Ou X,Hua Y,Liu J,et al.Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure:a meta-analysis of randomized controlled trials[J].CMAJ,2017,189(7):E260-E267.
3 Moreno FL,Hagan AD,Holmen JR,et al.Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function[J].Am J Cardiol,1984,53(4):579-585.
4 Nishimura M.For critically ill patients,is high-flow nasal cannula oxygen delivery a suitable alternative to mechanical ventilation?[J].Respir Care,2015,60(2):307-308.
5 Itagaki T,Okuda N,Tsunano Y,et al.Effect of highflow nasal cannula on thoraco-abdominal synchrony in adult critically ill patients[J].Respir Care,2014,59(1):70-74.
6 Papazian L,Corley A,Hess D,et al.Use of high-flow nasal cannula oxygenation in ICU adults:a narrative review[J].Intensive Care Med,2016,42(9):1336-1349.
7 Spoletini G,Alotaibi M,Blasi F,et al.Heated humidified high-flow nasal oxygen in adults:mechanisms of action and clinical implications[J].Chest,2015,148(1):253-261.
8 Barbier C,Loubières Y,Schmit C,et al.Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients[J].Intensive Care Med,2004,30(9):1740-1746.
9 Nishimura M.High-flow nasal cannula oxygen therapy in adults:physiological benefits,indication,clinical benefits,and adverse effects[J].Respir Care,2016,61(4):529-541.
10 Maggiore SM,Idone FA,Vaschetto R,et al.Nasal high-flow versus Venturi mask oxygen therapy after extubation.Effects on oxygenation,comfort,and clinical outcome[J].Am J Respir Crit Care Med,2014,190(3):282-288.
11 Stéphan F,Barrucand B,Petit P,et al.High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery:a randomized clinical trial[J].JAMA,2015,313(23):2331-2339.
12 Storgaard LH,Hockey HU,Laursen BS,et al.Longterm effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure[J].Int J Chron Obstruct Pulmon Dis,2018(13):1195-1205.
13 Hawkins S,Huston S,Campbell K,et al.High-flow,heated,humidified air via nasal cannula treats CPAP-intolerant children with obstructive sleep apnea[J].JClin Sleep Med,2017,13(8):981-989.
14 Roca O,Pérez-Terán P,Masclans JR,et al.Patients with New York Heart Association classⅢheart failure may benefit with high flow nasal cannula supportive therapy:high flow nasal cannula in heart failure[J].JCrit Care,2013,28(5):741-746.
15 CarrataláPerales JM,Llorens P,Brouzet B,et al.H-igh-Flow therapy via nasal cannula in acute heart failure[J].Rev Esp Cardiol,2011,64(8):723-725.
16么颖,余慕明,刘艳存,等.持续监测和控制人工气道气囊压力对机械通气患者呼吸机相关肺炎发生率影响的Meta分析[J/CD].中华危重症医学杂志(电子版),2016,9(6):389-393.
17张其霞,蔡晓丹,方振红,等.无镇静方案在综合ICU机械通气患者中的应用[J/CD].中华危重症医学杂志(电子版),2018,11(3):213-216.
18 Hernández G,Vaquero C,Colinas L,et al.Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients:a randomized clinical trial[J].JAMA,2016,316(15):1565-1574.
19 Hernández G,Vaquero C,Gonzalez P,et al.Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients:a randomized clinical trial[J].JAMA,2016,315(13):1354-1361.
20 Frat JP,Thille AW,Mercat A,et al.High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure[J].N Engl J Med,2015,372(23):2185-2196.
21 Roca O,Riera J,Torres F,et al.High-flow oxygen therapy in acute respiratory failure[J].Respir Care,2010,55(4):408-413.
22 Kang BJ,Koh Y,Lim CM,et al.Failure of high-flow nasal cannula therapy may delay intubation and increase mortality[J].Intensive Care Med,2015,41(4):623-632.
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