HFNC与NPPV治疗急性1型呼吸衰竭的临床效果比较

目的:比较经鼻高流量氧疗(High-flow Nasal Cannula,HFNC)与无创正压通气(Non-invasive positive pressure ventilation,NPPV)治疗1型呼吸衰竭的临床疗效及安全性。方法:选取2016年9月到2017年12月我院收治的急性1型呼吸衰竭患者46例,根据入院的顺序数字表法随机分为HFNC组和NPPV组,每组23例,分别给予HFNC治疗与NPPV治疗。比较两组治疗前及治疗后2 h、24 h、48 h的动脉血气pH值、动脉二氧化碳分压(Arterial carbon dioxide partial pressure,PaCO2)、动脉血氧分压(Arterial oxygen partial pressure,PaO2)、氧合指数、呼吸频率、心率等指标的变化情况。结果:两组动脉血气pH值治疗前、治疗后2 h、24 h、48 h比较无显著差异性(P0.05),组间比较也无显著性差异(P0.05);两组治疗后2 h、24 h及48 h PaO2和动脉血气氧合指数均显著高于治疗前,且随着时间的延长逐渐升高(P0.05),且治疗后48 h,NPPV组显著高于HFNC组(P0.05);两组治疗后2 h、24 h及48 h的PaCO2值与治疗前比较无显著性差异(P0.05),而治疗后48 h的PaCO2值NPPV组显著低于HFNC组(P0.05);两组治疗后2 h、24 h及48 h呼吸频率均显著低于治疗前,且随着时间逐渐降低(P0.05),且治疗后2 h、24 h及48 h的呼吸频率NPPV组显著高于HFNC组(P0.05);两组治疗后2 h、24 h及48 h心率显著低于治疗前,且随着时间的延长逐渐降低(P0.05),组间比较无显著性差异(P0.05)。结论:HFNC与NPPV治疗单纯1型呼吸衰竭的临床效果相当,但HFNC在提高患者治疗中的舒适度及耐受性等方面可能优于NPPV。

A Comparative Study on High-flow Nasal Cannula and Noninvasive Positive Pressure Ventilation in the Treatment of Type 1 Acute Respiratory Failure

ABSTRACT Objective: To investigate the clinical efficacy and safety of high-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NPPV) in the treatment of type 1 respiratory failure. Methods: 60 patients with acute type 1 respiratory failure admitted to our hospital from September 2016 to December 2017 were randomly divided into the HFNC group and the NPPV group according to the order of admission, 23 patients in each group were treated with HFNC and NPPV treatment respectively. The arterial blood gas pH value, PaCO₂, PaO₂, oxygenation index, respiratory rate, heart rate were compared before and at 2 h, 24 h and 48 h after treatment. Results: There was no significant difference in the pH value of arterial blood gas before treatment and at 2 h, 24 h and 48 h after treatment (P>0.05). The PaO₂ and arterial blood oxygenation index were significantly higher in the two groups at 2 h, 24 h and 48 h after treatment, and gradually increased with time (P<0.05), and at 48 h after treatment, it was significantly higher in the NPPV group than that of the HFNC group (P<0.05). The PaCO₂ values at 2 h, 24 h and 48 h after treatment showed no significant difference from those before treatment (P>0.05), while the PaCO₂ values in the NPPV group at 48 h after treatment were significantly lower than those in the HFNC group (P<0.05). The respiratory rate at 2 h, 24 h and 48 h after treatment was significantly lower than that before treatment, and gradually decreased with time (P<0.05), and the respiratory rate of NPPV group was significantly higher than those of the HFNC group at 2 h, 24 h and 48 h after treatment(P<0.05). The heart rate at 2 h, 24 h and 48 h after treatment were significantly lower than that before treatment, and gradually decreased with time (P<0.05). Conclusion: The clinical effect of HFNC and NPPV is comparable in the treatment of type 1 respiratory failure, but HFNC may be superior to NPPV in improving the comfort and tolerance during treatment.