经鼻高流量湿化氧气治疗对脑卒中后全身炎症反应综合征的疗效
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摘要
目的观察经鼻高流量湿化氧气治疗(HFNC)对急性脑卒中后全身炎症反应综合征(SIRS)的治疗效果。方法选取无锡市人民医院神经内科收治的83例脑卒中后SIRS患者(完成研究者78例),随机分为HFNC组(40例)和普通氧气治疗组(38例)。记录2组患者治疗前后的神经功能缺损评分(NIHSS)、APACHE-Ⅱ评分、肺部感染评分(CPIS),并检测患者血清C反应蛋白(CRP)。同时观察2组患者90 d时mRS评分。结果 HFNC组患者死亡或机械通气人数与普通氧气治疗组差异无统计学意义(P>0.05)。HFNC对脑卒中后SIRS患者7 d治愈率优于普通氧气治疗组(P <0.05),7 d APACHE-Ⅱ评分、7 dCPIS评分明显改善(P <0.05),同时HFNC可以改善这部分患者14 d NIHSS评分和3个月mRS评分(P <0.05)。2组患者的7和14 d血清CRP以及14 d CPIS评分差异无统计学意义(P> 0.05)。结论 HFNC可以改善急性脑卒中后SIRS患者的肺部感染情况,增加SIRS的治愈率,同时可以改善患者的神经功能缺损及预后。
Objective To observe the effect of heated humidified high flow nasal cannula oxygen therapy(HFNC) on patients with post-stroke systemic inflammatory response syndrome(SIRS). Methods Totally 78 patients with post-stroke SIRS were selected in the department of neurology of Wuxi People's Hospital and were randomly divided into HFNC group(n=40) and conventional therapy group(n = 38). The neurological impairment score(NIHSS), APACHE-Ⅱ, clinical pulmonary infection score( CPIS), C-reactive protein( CRP) of the 2 groups were recorded before and after the treatment. At the same time, modified Rankin score(mRS) of the two groups were also recorded. Results There was no significant difference in terms of morality and the number of patients with mechanical ventilation in the 2 groups. The 7-day APACHE Ⅱ, 7-day CPIS, 7-day SIRS cure rate, 14-day NIHSS and mRS of 3 months in HFNC group were higher than those in the conventional therapy group(P < 0.05).There was no significant difference in 7-day CRP, 14-day CRP and 14-day CPIS between HFNC group and conventional oxygen therapy group(P > 0.05). Conclusions HFNC can improve lung infection of patients with SIRS thus improve the recovery rate of SIRS. At the same time, it can improve the recovery of the neurological deficit and prognosis in acute stroke.
Objective To observe the effect of heated humidified high flow nasal cannula oxygen therapy(HFNC) on patients with post-stroke systemic inflammatory response syndrome(SIRS). Methods Totally 78 patients with post-stroke SIRS were selected in the department of neurology of Wuxi People's Hospital and were randomly divided into HFNC group(n=40) and conventional therapy group(n = 38). The neurological impairment score(NIHSS), APACHE-Ⅱ, clinical pulmonary infection score( CPIS), C-reactive protein( CRP) of the 2 groups were recorded before and after the treatment. At the same time, modified Rankin score(mRS) of the two groups were also recorded. Results There was no significant difference in terms of morality and the number of patients with mechanical ventilation in the 2 groups. The 7-day APACHE Ⅱ, 7-day CPIS, 7-day SIRS cure rate, 14-day NIHSS and mRS of 3 months in HFNC group were higher than those in the conventional therapy group(P < 0.05).There was no significant difference in 7-day CRP, 14-day CRP and 14-day CPIS between HFNC group and conventional oxygen therapy group(P > 0.05). Conclusions HFNC can improve lung infection of patients with SIRS thus improve the recovery rate of SIRS. At the same time, it can improve the recovery of the neurological deficit and prognosis in acute stroke.
引文
[1]张肖难,张泓.SOFA、qSOFA评分及SIRS标准对急诊疑似感染患者预测价值研究[J].中华急诊医学杂志,2018,27(3):259-264.
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[6]RELLO J,PEREZ M,ROCA O,et al.High-flow nasal therapy in adults with severe acute respiratory infection:a cohort study in patients with 2009 influenza A/H1N1v[J].J Crit Care,2012,27(5):434-439.
[7]妥亚军,侯滨,侯学智,等.经鼻高流量氧气湿化治疗重型高原肺水肿的疗效[J].实用医学杂志,2017,33(18):3156-3157.
[8]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[9]中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):258-273.
[10]BONE R C,BALK R A,CERRA F B,et al.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.The ACCP/SCCM Consensus Conference Committee.American College of Chest Physicians/Society of Critical Care Medicine[J].Chest,1992,101(6):1644-1655
[11]GOTERA C,DIAZ LOBATO S.Clinical evidence on high flow oxygen therapy and active humidification in adults[J].Rev Port Pneumol,2013,19(5):217-227.
[12]MIGLIETTA F,FANESCHI M L,LOBREGLIO G,et al.Procalcitonin,C-reactive protein and serum lactate dehydrogenase in the diagnosis of bacterial sepsis,SIRS and systemic candidiasis[J].Infez Med,2015,23(3):230-237.
[13]VIJAYGANAPATHY S,KARTHIKEYAN V S,SREENIVASJ,et al.Validation of APACHE II scoring system at 24 hours after admission as a prognostic tool in urosepsis:A prospective observational study[J].Investig Clin Urol,2017,58(6):453-459.
[14]窦志芳,陈乾华.脑钠肽联合CPIS评分在老年重症肺炎患者早期评估中的价值[J].实用医学杂志,2016,32(11):1893-1894.
[15]BOEHME A K,KAPOOR N,ALBRIGHT K C,et al.Systemic inflammatory response syndrome in tissue-type plasminogen activator-treated patients is associated with worse short-term functional outcome[J].Stroke,2013,44(8):2321-2323.
[16]于布为,吴新民,左明章,等.困难气道管理指南[J].临床麻醉学杂志,2013,29(1):93-98.
[17]FRAT J P,THILLE A W,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.
[18]LEVY S D,ALLADINA J W.High-flow oxygen therapy and other inhaled therapies in intensive care units[J].Lancet,2016,387(10030):1867-1878.
[19]GROVES N,TOBIN A.High flow nasal oxygen generates positive airway pressure in adult volunteers[J].Aust Crit Care,2007,20(4):126-131.
[2]倪健强,赵红如,何萍,等.后循环脑梗死诱发全身炎症反应综合征危险因素分析及对预后的影响[J].中国急救医学,2016,36(11):1023-1026.
[3]郭四平,倪健强,孙晓欣,等.急性脑梗死并发全身炎性反应综合征的危险因素分析及对患者预后的影响[J].中华老年心脑血管病杂志,2016,18(2):168-170.
[4]KALITA J,BASTIA J,BHOI S K,et al.Systemic inflammatory response syndrome predicts severity of stroke and outcome[J].J Stroke Cerebrovasc Dis,2015,24(7):1640-1648.
[5]THILE A W,MULLER G,GACOUIN A,et al.High-flow nasal cannula oxygen therapy alone or with non-invasive ventilation during the weaning period after extubation in ICU:the prospective randomised controlled HIGH-WEAN protocol[J].BMJOpen,2018,8(9):e023772.
[6]RELLO J,PEREZ M,ROCA O,et al.High-flow nasal therapy in adults with severe acute respiratory infection:a cohort study in patients with 2009 influenza A/H1N1v[J].J Crit Care,2012,27(5):434-439.
[7]妥亚军,侯滨,侯学智,等.经鼻高流量氧气湿化治疗重型高原肺水肿的疗效[J].实用医学杂志,2017,33(18):3156-3157.
[8]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[9]中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):258-273.
[10]BONE R C,BALK R A,CERRA F B,et al.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.The ACCP/SCCM Consensus Conference Committee.American College of Chest Physicians/Society of Critical Care Medicine[J].Chest,1992,101(6):1644-1655
[11]GOTERA C,DIAZ LOBATO S.Clinical evidence on high flow oxygen therapy and active humidification in adults[J].Rev Port Pneumol,2013,19(5):217-227.
[12]MIGLIETTA F,FANESCHI M L,LOBREGLIO G,et al.Procalcitonin,C-reactive protein and serum lactate dehydrogenase in the diagnosis of bacterial sepsis,SIRS and systemic candidiasis[J].Infez Med,2015,23(3):230-237.
[13]VIJAYGANAPATHY S,KARTHIKEYAN V S,SREENIVASJ,et al.Validation of APACHE II scoring system at 24 hours after admission as a prognostic tool in urosepsis:A prospective observational study[J].Investig Clin Urol,2017,58(6):453-459.
[14]窦志芳,陈乾华.脑钠肽联合CPIS评分在老年重症肺炎患者早期评估中的价值[J].实用医学杂志,2016,32(11):1893-1894.
[15]BOEHME A K,KAPOOR N,ALBRIGHT K C,et al.Systemic inflammatory response syndrome in tissue-type plasminogen activator-treated patients is associated with worse short-term functional outcome[J].Stroke,2013,44(8):2321-2323.
[16]于布为,吴新民,左明章,等.困难气道管理指南[J].临床麻醉学杂志,2013,29(1):93-98.
[17]FRAT J P,THILLE A W,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.
[18]LEVY S D,ALLADINA J W.High-flow oxygen therapy and other inhaled therapies in intensive care units[J].Lancet,2016,387(10030):1867-1878.
[19]GROVES N,TOBIN A.High flow nasal oxygen generates positive airway pressure in adult volunteers[J].Aust Crit Care,2007,20(4):126-131.