摘要
目的研究经鼻高流量氧疗(high flow nasal cannula oxygen therapy,HFNC)对比无创正压通气(noninvasive positive pressure ventilation,NPPV)在急性心力衰竭(acute heart failure,AHF)伴Ⅰ型呼吸衰竭患者的治疗效果。方法选择2022年1月至2022年12月首都医科大学宣武医院急诊科收治的94例AHF伴Ⅰ型呼吸衰竭患者,随机分为观察组48例和对照组46例。两组患者均给予常规扩血管、利尿等治疗,对照组给予NPPV治疗,观察组给予HFNC治疗,分别比较两组患者治疗前、治疗24 h后的呼吸频率、心率、血清N末端B型利钠肽原(NT-proBNP)、动脉氧分压(PaO_(2))和动脉二氧化碳分压(PaCO_(2))的变化情况及2组比较的区别,应用调查问卷评估两组患者治疗舒适度的区别。随访28 d,分别比较两组患者治疗后误吸、胃胀气等并发症发生率、气管插管率及病死率。结果观察组与对照组治疗后的呼吸频率、心率和NT-proBNP较前明显降低(P均<0.05),PaO_(2)较前升高(P均<0.05),PaCO_(2)较前升高(P<0.05),但仍在正常范围内;观察组治疗后呼吸频率是(23.77±2.36)次/min、心率为(89.17±5.80)次/min、NT-proBNP为[13631.00(9997.25,16328.00)]pg/ml、PaO_(2)为(66.87±2.78)mmHg和PaCO_(2)为(37.06±2.56)mmHg,与对照组的(23.33±2.81)次/min、(87.69±5.02)次/min、[12517.00(9836.75,17742.00)]pg/ml、(67.74±2.67)mmHg和(37.07±1.93)mm Hg比较无统计学差别(均P>0.05);调查问卷显示,观察组舒适度评分大于对照组[(3.35±0.69)分比(2.76±0.77)分,P=0.001],并发症发生率小于对照组(10.41%比28.26%,P=0.028),两组患者气管插管率(12.50%比10.86%)和病死率(10.41%比8.69%)比较无统计学差别(P>0.05)。结论HFNC和NPPV在AHF伴Ⅰ型呼吸衰竭患者中应用均具有较好的治疗效果,但HFNC并发症较较少,患者舒适程度更高。
Objective To study the therapeutic effect of high flow nasal cannula oxygen therapy(HFNC)compared to non-invasive positive pressure ventilation(NPPV)in acute heart failure patients(AHF)with type 1 respiratory failure.Methods A total of 94 elderly AHF patients with type 1 respiratory failure were randomly divided into the observation group(48 cases)and control group(46 cases)in the emergency department of Xuanwu Hospital of Capital Medical University from January 2022 to December 2022.Both 2 groups were treated with conventional vasodilation and diuresis;the control group was treated with NPPV,and the observation group was treated with HFNC.The changes of respiratory rate,heart rate,serum NT-proBNP,arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))were compared between the two groups before and after 24 h treatment.The differences of treatment comfort between the two groups were evaluated with questionnaires.After 28 days of follow-up,the differences between the two groups in the incidence of complications such as aspiration,bloating,tracheal intubation rate and mortality rate were compared.Result After treatment,the respiratory rate,heart rate and NT-proBNP of the 2 groups were significantly lower(all P<0.05)with higher PaO_(2)(all P<0.05)and PaCO_(2)(all P<0.05).After treatment,the respiratory rate,heart rate,NT-proBNP PaO_(2) and PaCO_(2) in the observation group were(23.77±2.36)beats/min,(89.17±5.80)beats/min,[13631.00(9997.25,16328.00)]pg/ml,(66.87±2.78)mmHg,and(37.06±2.56)mmHg respectively;the corresponding indicators of the control group were(23.33±2.81)times/min,(87.69±5.02)times/min,[12517.00(9836.75,17742.00)]pg/ml,(67.74±2.67)mmHg and(37.07±1.93)mmHg respectively;there was no statistically significant difference between the two groups(all P>0.05).The questionnaire showed that the comfort score of the observation group was higher than that of the control group[(3.35±0.69)vs.(2.76±0.77),P=0.001]and the incidence of complications was lower than that in the control group(10.41%vs.28.26%,P=0.028);but there was no statistically significant difference in the tracheal intubation rate(12.50%vs.10.86%)and mortality rate(10.41%vs.8.69%)between the two groups of patients(P>0.05).Conclusion The application of HFNC and NPPV in AHF patients with type I respiratory failure has good therapeutic effect,but the complications of HFNC were less and the patients'comfort was higher.
作者
武亚梅
王晶
唐娜
WU Ya-mei;WANG Jing;TANG Na(Department of Emergency,XuanWu Hospital of Capital Medical University,BeiJing 100053,China)
出处
《中国心血管病研究》
CAS
2024年第2期131-135,共5页
Chinese Journal of Cardiovascular Research
基金
国家重点研发计划课题(2020YFC2005402)。
关键词
急性心力衰竭
Ⅰ型呼吸衰竭
经鼻高流量氧疗
无创正压通气
Acute heart failure
Type 1 respiratory failure
High flow nasal cannula oxygen therapy
Noninvasive positive pressure ventilation
