经鼻高流量鼻导管湿化氧疗治疗中老年重症难治性肺炎合并呼吸衰竭的临床观察
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摘要
目的观察经鼻高流量鼻导管湿化氧疗治疗中老年重症难治性肺炎合并呼吸衰竭患者疗效及其对氧饱和度及预后的影响。方法 2016年4月-2018年4月河北省衡水市第二人民医院呼吸消化科诊疗重症难治性肺炎合并呼吸衰竭患者240例,随机数字表法分成2组,每组120例。对照组给予抗炎、平喘以及化痰等常规治疗联合经鼻正压通气吸氧治疗,观察组在常规治疗基础上给予经鼻高流量鼻导管湿化氧疗治疗。观察比较2组患者紫绀、气短以及肺部啰音等症状消失时间、生活质量及呼吸困难情况,以及动脉血气分析、氧饱和度改善及炎性因子变化。结果治疗后,观察组肺部啰音消失时间、气短消失时间、紫绀消失时间、SGRQ评分、Borg评分、IL-1、TNF-α、CRP水平、PaO_2、SaO_2、PaCO_2均优于对照组,差异均有统计学意义(t/P=10. 077/0. 000、12. 532/0. 000、17. 553/0. 000、14.483/0.000 15. 458/0. 000、21. 289/0. 000、19. 999/0. 000、24. 498/0. 000、16. 872/0. 000、8. 401/0. 000、7. 264/0.000)。结论采用经鼻高流量鼻导管湿化氧疗,能够改善重症难治性肺炎合并呼吸衰竭患者呼吸困难,促进疾病相关临床症状恢复,可以有效控制病情发展,改善患者预后。
Objective To observe the effect of nasal high-flow nasal catheter humidification oxygen therapy on the treatment of elderly patients with severe refractory pneumonia complicated with respiratory failure and its effect on oxygen saturation and prognosis. Methods From April 2016 to April 2018.240 patients with severe refractory pneumonia complicated with respiratory failure were treated by the Department of Respiratory and Gastroenterology, Second Peoples Hospital of Hengshui City,Hebei Province. The random number table method was divided into two groups, 120 cases in each group. The control group was given conventional treatments such as anti-inflammatory,antiasthmatic and phlegm combined with nasal positive pressure ventilation. The observation group was given a high-flow nasal catheter humidification oxygen therapy on the basis of conventional treatment. The disappearance time, quality of life and dyspnea of symptoms such as purpura, shortness of breath and lung vocalization were observed in the two groups. Arterial blood gas analysis, oxygen saturation improvement and inflammatory factors were observed. Results After treatment, the disappearance time of lung voice, disappearance time of air shortness, disappearance time of purpura, SGRQ score, Borg score, IL-1, TNF-α, CRP level, PaO_2, SaO_2, PaCO_2 were better than those of the control group. Significance(t/P = 10.077/0.000,t/P = 12.532/0.000, t/P = 17.553/0.000, t/P = 14.483/0.000, t/P = 15.458/0.000, t/P = 21.289/0.000, t/P = 19.999/0. 000, t/P = 24. 498/0.000, t/P = 16. 872/0.000,t/P = 8.401/0.000, t/P =7.264/0.000). Conclusion The use of nasal high-flow nasal catheter humidification oxygen therapy can improve the dyspnea of patients with severe refractory pneumonia complicated with respiratory failure, promote the recovery of disease-related clinical symptoms, and effectively control the development of the disease and improve the prognosis of patients.
Objective To observe the effect of nasal high-flow nasal catheter humidification oxygen therapy on the treatment of elderly patients with severe refractory pneumonia complicated with respiratory failure and its effect on oxygen saturation and prognosis. Methods From April 2016 to April 2018.240 patients with severe refractory pneumonia complicated with respiratory failure were treated by the Department of Respiratory and Gastroenterology, Second Peoples Hospital of Hengshui City,Hebei Province. The random number table method was divided into two groups, 120 cases in each group. The control group was given conventional treatments such as anti-inflammatory,antiasthmatic and phlegm combined with nasal positive pressure ventilation. The observation group was given a high-flow nasal catheter humidification oxygen therapy on the basis of conventional treatment. The disappearance time, quality of life and dyspnea of symptoms such as purpura, shortness of breath and lung vocalization were observed in the two groups. Arterial blood gas analysis, oxygen saturation improvement and inflammatory factors were observed. Results After treatment, the disappearance time of lung voice, disappearance time of air shortness, disappearance time of purpura, SGRQ score, Borg score, IL-1, TNF-α, CRP level, PaO_2, SaO_2, PaCO_2 were better than those of the control group. Significance(t/P = 10.077/0.000,t/P = 12.532/0.000, t/P = 17.553/0.000, t/P = 14.483/0.000, t/P = 15.458/0.000, t/P = 21.289/0.000, t/P = 19.999/0. 000, t/P = 24. 498/0.000, t/P = 16. 872/0.000,t/P = 8.401/0.000, t/P =7.264/0.000). Conclusion The use of nasal high-flow nasal catheter humidification oxygen therapy can improve the dyspnea of patients with severe refractory pneumonia complicated with respiratory failure, promote the recovery of disease-related clinical symptoms, and effectively control the development of the disease and improve the prognosis of patients.
引文
[1]李文龙,张华,徐超,等.经鼻高流量氧疗治疗特发性肺纤维化并呼吸衰竭[J].实用医学杂志,2017,33(15):2603-2604.DOI:10.3969/j. issn. 1006-5725.2017.15.047.
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[10]张征,郭闯.经鼻高流量吸氧对老年呼吸功能衰竭患者呼吸机使用率的影响[J].护士进修杂志,2018,33(11):1027-1030.DOI:10.16821/j. cnki. hsjx. 2018.11.019.
[11]洪林杰,黄种杰,范洪涛,等.老年慢性阻塞性肺疾病患者合并呼吸机相关性肺炎的病原菌分布变迁及耐药性分析[J].疑难病杂志,2018,17(3):226-229. DOI:10. 3969/j. issn. 1671-6450. 2018.03.003.
[12]韩朋飞,赵嘉,党治国,等.氨溴索辅助治疗成人重症肺炎疗效及其对肺功能指标、炎性因子的影响[J].疑难病杂志,2018,17(1):10-13.DOI:10.3969/j. issn. 1671-6450.2018.01.003.
[13] Coudroy R,Jamet A,Petua P,et al. High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure:An observational cohort study[J]. Ann Intensive Care, 2016,6(1):45. DOI:10. 1186/s13613-016-0151-7
[14]周权,徐化强,鞠涛,等.胸腺肽对重症呼吸机相关性肺炎患者心肌相关标志物和T淋巴细胞亚群的影响[J].疑难病杂志,2017,16(12):1229-1232. DOI:10. 3969/j. issn. 1671-6150. 2017. 112.011.
[15]储蕴,郭闯,赵丽艳.经鼻高流量吸氧与无创机械通气治疗术后呼吸功能衰竭的效果比较[J].中国实用护理杂志,2016,32(19):1483-1485. DOI:10. 3760/cma. j. issn. 1672-7088. 2016.19.011.
[16]程燕雯,杜辛歌,王迎难,等.沙丁胺醇联合布地奈德对重症肺炎合并呼吸窘迫综合征患者心功能及血气分析的影响[J].疑难病杂志,2016,15(4):362-365. DOI:10. 3969/j. issn. 1671-6450.2016.04.009.
[17]王可,徐思成,左蕾,等.经鼻高流量吸氧治疗急性呼吸衰竭的系统评价[J].中华急诊医学杂志,2017,26(8):879,884.
[18] Goncalves-Venade G, Lacerda-Principe N, Roncon-Albuquerque R Jr,et al. Extracorporeal membrane oxygenation for refractory severe respiratory failure in acute interstitial pneumonia[J]. Artif Organs,2018,42(5):569-574. DOI:10.1111/aor. 13075.
[19]程晓叁,余定红.经鼻高流量鼻导管湿化氧疗治疗中老年重症难治性肺炎合并呼吸衰竭的疗效[J].实用临床医药杂志,2018,22(1):10-13. DOI:10. 7619/jcmp. 201801004.
[20] Frat JP,Ricard JD,Coudroy R,et al. Preoxygenation with non-invasive ventilation versus high-flow nasal cannula oxygen therapy for intubation of patients with acute hypoxaemic respiratory failure in ICU:the prospective randomised controlled FLORALI-2 study protocol[J]. BMJ Open,2017,7(12):e018611. DOI:10. 1136/bmjopen-2017-018611.
[21]高敏,韩小彤,文辉,等.经鼻高流量氧疗在成人呼吸衰竭患者中的应用进展[J].医学综述,2017,23(22):4468-4472. DOI:10.3969/j. issn. 1006-2084.2017.22.019.
[22]王晓丹,张玉想.经鼻高流量湿化氧疗在急性呼吸衰竭中的作用研究进展[J].国际呼吸杂志,2017,37(6):477-480.DOI:10.3760/cma. j. issn. 1673-436X. 2017.06.017.
[2] 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. DOI:10.4187/respcare. 04577.
[3]范永强,刘春香,王虹,等.高流量湿化氧疗仪在RICU中应用效果观察[J].临床肺科杂志,2018,23(3):450-452.DOI:10.3969/j. issn. 1009-6663.2018.03.017.
[4]许云波,程红斌.经鼻高流量鼻导管湿化氧疗治疗新生儿肺炎合并呼吸衰竭的临床疗效[J].中国妇幼保健,2017,32(13):3077-3080. DOI:10.7620/zgfybj. j. issn. 1001-4411.2017.13.87.
[5] Koppers RJ,Vos PJ,Boot CR,et al. Exercise Performante improvesbin patients with COPD due to respiratory muscle endurance training[J]. Chest,2006,129(4):886-892.
[6] Swigris J J,Esser D,Conoscenti C S,et al. The psychometric properties of the st george s respiratory questionnaire(SGRQ)in patientswith idiopathic pulmonary fibrosis:a literature Review[J]. Health Qual Life Outcomes,2014,12(1):124.
[7] Chikata Y,Ohnishi S,Nishimura M. Humidity and inspired oxygen concentration during high-flow nasal cannula therapy in neonatal and infant lung models[J]. Respir Care, 2017,62(5):532-537. DOI:10.4187/respcare. 05319.
[8]代光华,李丹丹.高流量鼻导管氧疗联合维生素营养补充剂对新生儿肺炎合并呼吸衰竭的效果观察[J].解放军医药杂志,2016,28(10):61-64. DOI:10.3969/j.issn. 2095-140X. 2016.10.017.
[9]王丽娟,夏金根,杨晓军.成人经鼻高流量氧气湿化治疗的应用进展[J].中华结核和呼吸杂志,2016,39(2):153-157. DOI:10.3760/cma. j. issn. 1001-0939.2016.02.022.
[10]张征,郭闯.经鼻高流量吸氧对老年呼吸功能衰竭患者呼吸机使用率的影响[J].护士进修杂志,2018,33(11):1027-1030.DOI:10.16821/j. cnki. hsjx. 2018.11.019.
[11]洪林杰,黄种杰,范洪涛,等.老年慢性阻塞性肺疾病患者合并呼吸机相关性肺炎的病原菌分布变迁及耐药性分析[J].疑难病杂志,2018,17(3):226-229. DOI:10. 3969/j. issn. 1671-6450. 2018.03.003.
[12]韩朋飞,赵嘉,党治国,等.氨溴索辅助治疗成人重症肺炎疗效及其对肺功能指标、炎性因子的影响[J].疑难病杂志,2018,17(1):10-13.DOI:10.3969/j. issn. 1671-6450.2018.01.003.
[13] Coudroy R,Jamet A,Petua P,et al. High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure:An observational cohort study[J]. Ann Intensive Care, 2016,6(1):45. DOI:10. 1186/s13613-016-0151-7
[14]周权,徐化强,鞠涛,等.胸腺肽对重症呼吸机相关性肺炎患者心肌相关标志物和T淋巴细胞亚群的影响[J].疑难病杂志,2017,16(12):1229-1232. DOI:10. 3969/j. issn. 1671-6150. 2017. 112.011.
[15]储蕴,郭闯,赵丽艳.经鼻高流量吸氧与无创机械通气治疗术后呼吸功能衰竭的效果比较[J].中国实用护理杂志,2016,32(19):1483-1485. DOI:10. 3760/cma. j. issn. 1672-7088. 2016.19.011.
[16]程燕雯,杜辛歌,王迎难,等.沙丁胺醇联合布地奈德对重症肺炎合并呼吸窘迫综合征患者心功能及血气分析的影响[J].疑难病杂志,2016,15(4):362-365. DOI:10. 3969/j. issn. 1671-6450.2016.04.009.
[17]王可,徐思成,左蕾,等.经鼻高流量吸氧治疗急性呼吸衰竭的系统评价[J].中华急诊医学杂志,2017,26(8):879,884.
[18] Goncalves-Venade G, Lacerda-Principe N, Roncon-Albuquerque R Jr,et al. Extracorporeal membrane oxygenation for refractory severe respiratory failure in acute interstitial pneumonia[J]. Artif Organs,2018,42(5):569-574. DOI:10.1111/aor. 13075.
[19]程晓叁,余定红.经鼻高流量鼻导管湿化氧疗治疗中老年重症难治性肺炎合并呼吸衰竭的疗效[J].实用临床医药杂志,2018,22(1):10-13. DOI:10. 7619/jcmp. 201801004.
[20] Frat JP,Ricard JD,Coudroy R,et al. Preoxygenation with non-invasive ventilation versus high-flow nasal cannula oxygen therapy for intubation of patients with acute hypoxaemic respiratory failure in ICU:the prospective randomised controlled FLORALI-2 study protocol[J]. BMJ Open,2017,7(12):e018611. DOI:10. 1136/bmjopen-2017-018611.
[21]高敏,韩小彤,文辉,等.经鼻高流量氧疗在成人呼吸衰竭患者中的应用进展[J].医学综述,2017,23(22):4468-4472. DOI:10.3969/j. issn. 1006-2084.2017.22.019.
[22]王晓丹,张玉想.经鼻高流量湿化氧疗在急性呼吸衰竭中的作用研究进展[J].国际呼吸杂志,2017,37(6):477-480.DOI:10.3760/cma. j. issn. 1673-436X. 2017.06.017.