加温湿化高流量鼻导管通气对急性低氧性呼吸衰竭的疗效观察
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摘要
目的分析加温湿化高流量鼻导管通气(HHFNC)对急性低氧性呼吸衰竭(AHRF)的疗效。方法选择2017年1月至2018年1月该院呼吸内科收治的AHRF患者80例,按照入院顺序分为对照组和观察组。对照组40例,低流量氧疗,吸氧浓度25%～30%,每日维持16h,检测患者的经皮血氧饱和度在90%以上,观察患者的神志、呼吸频率、结膜水肿、血气分析等情况,若出现二氧化碳潴留,则经鼻持续正压通气,直至纠正低氧血症。严重的患者改为气管插管或气管切开。观察组40例,鼻导管氧疗,流量3～8L/min,氧浓度维持在30%左右,维持血氧饱和度90%左右,维持整个呼吸周期内气道压力正压,再采用输液泵持续间断湿化治疗,速度4～6mL/h,最大不超过10mL/h,维持时间每日≥5h。对比两组患者的预后指标,患者及家属的评价结果。结果观察组患者转机械通气率低于对照组,差异有统计学意义(P<0.05)。观察组患者吸氧时间、低氧血症持续时间低于对照组,差异有统计学意义(P<0.05)。观察组患者不耐受、浓痰、鼻黏膜损伤发生率低于对照组,差异有统计学意义(P<0.05)。观察组患者吸氧舒适性、责任护士护理操作难易程度评分高于对照组,差异有统计学意义(P<0.05)。结论 HHFNC治疗AHRF可使患者获益,降低机械通气风险,快速纠正低氧血症,降低不良事件发生风险,提升患者的舒适性,减轻护理操作的负担。
Objective To analyze the efficacy of heating nasal high flow humidification oxygen inhalation therapy(HHFNC)for treating acute hypoxic respiratory failure(AHRF).Methods Eighty patients with AHRF admitted to the respiration department of this hospital from January 2017 to January 2018 were grouped into the control group and observation group according to the order of admission.In the control group,40 cases,low flow oxygen therapy,oxygen concentration 25%-30%,daily maintaining for 16 h,the measured percutaneous oxygen saturation was more than 90%,the patients′situation such as aspiration,respiratory frequency,conjunctive edema and blood gas analysis were observed.If carbon dioxide retention appeared,the nasal continuous positive pressure was used until the hypoxemia was corrected.The serious case was changed to tracheal intubation or tracheotomy.In the observation group,40 cases were treated with nasal catheter oxygen therapy,the flow quantity was 3-8 L/min,the oxygen concentration was about 30%,the oxygen saturation was maintained about 90%,the positive pressure of airway pressure was maintained throughout the respiratory cycle,and the continuous intermittent humidification was used in the infusion pump,the speed was 4-6 mL/h,the maximum was not more than 10 mL/h,and the duration of the maintenance was≥5 hper day.The prognostic indicators,evaluation results of patients and their family members were compared between the two groups.Results The mechanical ventilation rate in the observation group was lower than that in the control group with statistically significant difference(P<0.05).The oxygen intake time and the duration of hypoxemia in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence rates of intolerance,sputum and nasal mucosa injury in the observation group were lower than those in the control group(P<0.05).The oxygen comfort of the observation group and the score of nursing operating difficulty degree of responsibility nurses in the observation group were higher than those in the control group,and the difference ws statistically significant(P<0.05).Conclusion HHFNC for treating AHRF can make the patients to obtain the benefit,reduces the risk of mechanical ventilation,quickly correct hypoxemia,reduces the risk of adverse events occurence,improves the comfort of the patients,and reduces the burden of nursing operation.
Objective To analyze the efficacy of heating nasal high flow humidification oxygen inhalation therapy(HHFNC)for treating acute hypoxic respiratory failure(AHRF).Methods Eighty patients with AHRF admitted to the respiration department of this hospital from January 2017 to January 2018 were grouped into the control group and observation group according to the order of admission.In the control group,40 cases,low flow oxygen therapy,oxygen concentration 25%-30%,daily maintaining for 16 h,the measured percutaneous oxygen saturation was more than 90%,the patients′situation such as aspiration,respiratory frequency,conjunctive edema and blood gas analysis were observed.If carbon dioxide retention appeared,the nasal continuous positive pressure was used until the hypoxemia was corrected.The serious case was changed to tracheal intubation or tracheotomy.In the observation group,40 cases were treated with nasal catheter oxygen therapy,the flow quantity was 3-8 L/min,the oxygen concentration was about 30%,the oxygen saturation was maintained about 90%,the positive pressure of airway pressure was maintained throughout the respiratory cycle,and the continuous intermittent humidification was used in the infusion pump,the speed was 4-6 mL/h,the maximum was not more than 10 mL/h,and the duration of the maintenance was≥5 hper day.The prognostic indicators,evaluation results of patients and their family members were compared between the two groups.Results The mechanical ventilation rate in the observation group was lower than that in the control group with statistically significant difference(P<0.05).The oxygen intake time and the duration of hypoxemia in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence rates of intolerance,sputum and nasal mucosa injury in the observation group were lower than those in the control group(P<0.05).The oxygen comfort of the observation group and the score of nursing operating difficulty degree of responsibility nurses in the observation group were higher than those in the control group,and the difference ws statistically significant(P<0.05).Conclusion HHFNC for treating AHRF can make the patients to obtain the benefit,reduces the risk of mechanical ventilation,quickly correct hypoxemia,reduces the risk of adverse events occurence,improves the comfort of the patients,and reduces the burden of nursing operation.
引文
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[15]JEONG J H,KIM D H,KIM S C,et al.Changes inarterial blood gases after use of high-flow nasal can-nula therapy in the ED[J].Am J Emerg Med,2015,33(10):1344-1349.
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[3]乐静,陈苓.急性低氧性呼吸衰竭患儿呼吸支持疗法的疗效影响因素分析[J].安徽医学,2017,38(8):1061-1064.
[4]李修晶,王永军,摆翔.急性低氧性呼吸衰竭患儿呼吸支持疗法影响因素的Logistic分析[J].中国妇幼保健,2017,32(20):4988-4991.
[5]乐静,陈苓.急性低氧性呼吸衰竭患儿呼吸支持疗法的疗效影响因素分析[J].安徽医学,2017,38(8):1061-1064.
[6]谯燕群,陈琼,容玉佩,等.加温加湿高流量鼻导管吸氧治疗在重症成人患者中的研究进展[J].医学综述,2016,22(18):3595-3599.
[7] MONRO-SOMERVILLE T,SIM M,RUDDY J,et al.The effect of high-flow nasal cannula oxygen therapy on mortality and intubation rate in acute respiratory failure:a systematic review and meta analysis[J].Crit Care Med,2017,45(4):E449-E456.
[8]黄华平,陈斌,王海燕.经鼻导管高流量吸氧在危重患者气管插管拔除后应用效果的Meta分析[J].护理管理杂志,2017,17(6):399-401.
[9] MIGUEL-MONTANES R,HAJAGE D,MESSIKA J,et al.Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia[J].Crit Care Med,2015,43(3):574-583.
[10]陈配配,董丽秀,叶波,等.高流量吸氧湿化仪与无创呼吸机对呼吸衰竭患者的疗效比较[J].海南医学,2017,28(2):291-293.
[11]ESTEBAN A,FRUTOS-VIVAR F,MURIEL A,et al.Evolution of mortality over time in patients receiving mechanical ventilation[J].Am J Respir Crit Care Med,2013,188(2):220-230.
[12]黄桃,何发明,郭睿,等.经鼻高流量湿化氧吸入疗法对急性低氧性呼吸衰竭的疗效研究[J].重庆医学,2016,45(34):4769-4771.
[13]罗裕锋,瞿嵘,凌云,等.中国首例输入性中东呼吸综合征患者经鼻高流量氧疗的效果观察[J].中华危重病急救医学,2015,27(10):841-844.
[14]陆朝强.无创双水平正压通气技术在老年重症慢性阻塞性肺疾病急性重期治疗中的应用[J].海南医学,2013,24(24):3685-3687.
[15]JEONG J H,KIM D H,KIM S C,et al.Changes inarterial blood gases after use of high-flow nasal can-nula therapy in the ED[J].Am J Emerg Med,2015,33(10):1344-1349.