摘要
目的:对比及评价经鼻高流量氧疗(HFNC)和无创正压通气(NPPV)对于肺源性中重度急性呼吸窘迫综合征(ARDS)患者的初始治疗效果。方法:采用回顾观察性研究,选择2016-01-01—2018-08-01期间因肺源性中重度ARDS入住我院急诊ICU的患者,且给予常规氧疗后低氧不能缓解。根据患者入院后最高的无创氧疗方案将患者分为经鼻高流量(HFNC)组及无创通气(NPPV)组,所有患者的无创氧疗方案选择为随机进行。主要观察指标为90 d病死率,次要观察指标为患者28 d气管插管率。结果:41例患者纳入分析,患者来自中国11个省,入院原因均为重症肺炎,入住ICU时氧合指数(PaO2/FiO2)均≤200 mmHg。所有患者的90 d病死率为49%(20/41),28 d气管插管率为51%(21/41)。HFNC组26例患者,90 d病死率为42%(11/26),28 d气管插管率为42%(11/26);NPPV组15例患者,90 d病死率为60%(9/15),28 d气管插管率为67%(10/15)。HFNC组和NPPV组90 d病死率及28 d气管插管率差异无统计学意义。根据患者基础免疫功能将所有患者分为非免疫抑制患者及免疫抑制患者,非免疫抑制患者共23例,其中HFNC组14例,NPPV组9例,HFNC非免疫抑制组患者90 d病死率及28 d插管率显著低于NPPV组患者(14%vs.67%,P=0.008;14%vs.67%,P=0.01)。免疫抑制患者共18例,其中HFNC组12例,NPPV组6例,使用HFNC患者的90 d病死率及28 d插管率与NPPV组患者差异无统计学意义(75%vs.50%,P=0.46;75%vs.67%,P=0.71)。结论:与NPPV比较,对于非免疫抑制肺源性中重度ARDS患者采用HFNC初始治疗可显著降低病死率及气管插管率,是一种较为理想的无创氧疗方案。
Objective:To evaluate and compare the therapeutic efficacy of HFNC and NPPV in patients with pulmonary ARDS. Method:A retrospective observational single-center study was performed patients admitted to the ICU of Peking Union Medical College Hospital for pulmonary ARDS from January 01,2016 to August 01, 2018 with oxygen index(PaO2/FiO2) ≤200 mmHg were selected and were randomly divided into HFNC group and NPPV group. The primary observation index was the 90-day mortality rate, and the secondary observation index was the 28-day tracheal intubation rate. Result:Forty-one patients were included. According to the patients’ basic immunity status, all patients were divided into non-immunosuppressed group(n=23) and immunosuppressed group(n=18). The 90-day mortality and 28-day intubation rates of patients with HFNC were significantly lower than the ones with NPPV in non-immunosuppressed group(14% vs. 67%, P=0.008;14% vs. 67%, P=0.01, respectively). The 90-day mortality and 28-day intubation rates of patients with HFNC were not significantly different from the ones with NPPV in immunosuppressed group(75% vs. 50%, P=0.46;75% vs. 67%, P=0.71, respectively.). Conclusion:Compared with traditional NPPV, the use of HFNC therapy as an initial treatment for non-immunosuppressed pulmonary moderate and severe pulmonary ARDS patients may significantly reduce mortality in 90-days and intubation rate.
作者
刘霜
朱华栋
于学忠
徐胜勇
徐军
LIU Shuang;ZHU Huadong;YU Xuezhong;XU Shengyong;XU Jun(Department of Emergency,Peking Union Medical College Hospital,Beijing,100730,China)
出处
《临床急诊杂志》
CAS
2020年第3期181-187,共7页
Journal of Clinical Emergency
基金
中国医学科学院医学与健康科技创新工程(No:2017-I2M-1-009).
关键词
经鼻高流量氧疗
无创正压通气
机械通气
重症肺炎
急性呼吸窘迫综合征
high-flow nasal cannula oxygen
noninvasive positive pressure ventilation
mechanical ventilation
severe pneumonia
acute respiratory distress syndrome
作者简介
通信作者:徐军,E-mail:Xujunfree@126.com
