摘要
目的:探讨无创正压通气(Non-invasive positive pressure ventilation,NIPPV)与经鼻高流量湿化氧疗(High-flow nasal cannula,HFNC)交替疗法在急重症呼吸衰竭患者急救中的应用。方法:选取2023年9月~2024年8月鄱阳县人民医院重症监护室收治的60例急重症呼吸衰竭患者作为研究对象,采用简单数字表法分为HFNC组和NIPPV组,各30例,HFNC组采用HFNC呼吸支持治疗,NIPPV组予以NIPPV与HFNC交替疗法,对比治疗前、治疗3 d后两组血气指标、肺功能、呼吸动力学指标、血清指标,并统计不良事件发生情况、机械通气时间、ICU入住时间。结果:治疗3 d后,NIPPV组血二氧化碳分压(Partial pressure of carbon dioxide,PaCO_(2))、气道峰压(Peak inspiratory pressure,PIP)、气道阻力(Airway resistance,Raw)、呼吸做功(Work of breathing,WOB)、单核细胞分布宽度(Monocyte distribution width,MDW)、中性粒细胞与淋巴细胞比例(Neutrophil to lymphocyte ratio,NLR)、降钙素原(Procalcitonin,PCT)、脑钠肽(Brain natriuretic peptide,BNP)、不良反应发生率均明显低于HFNC组(P<0.05),机械通气时间、住院时间短于HFNC组(P<0.05);NIPPV组血氧饱和度(Oxygen saturation,SaO_(2))、血氧分压(Partial pressure of oxygen,PaO_(2))、氧合指数(Oxygenation index,OI)、用力肺活量(Forced vital capacity,FVC)、最大呼气流速(Peak expiratory flow rate,PEF)、第1秒最大呼气量(Forced expiratory volume in one second,FEV1)、FEV1占预计值的百分比(Forced expiratory volume in the first second predicted,FEV1%pred)均明显高于HFNC组(P<0.05)。结论:相较于HFNC治疗,NIPPV与HFNC交替疗法应用于急重症呼吸衰竭患者急救中可显著改善血气指标与呼吸动力学指标,有助于肺功能恢复,同时减轻机体炎症与心肌损伤,降低不良事件发生,促进预后恢复。
Objective:To investigate the application of alternating therapy with non-invasive positive pressure ventilation(NIPPV)and high-flow nasal cannula(HFNC)oxygen therapy in first aid of patients with severe acute respiratory failure.Methods:Sixty patients with severe acute respiratory failure who were admitted to the intensive care unit of People's Hospital of Poyang County from September 2023 to August 2024 were selected.Using a simple number table,they were divided into HFNC group and NIPPV group,with 30 cases in each group.HFNC group was given HFNC oxygen therapy,while NIPPV group was given alternating therapy with NIPPV and HFNC oxygen therapy.Blood gas indexes,pulmonary function,pneodynamics,and serum indexes were compared between the two groups before treatment and after 3 days of treatment.The incidence of adverse events,duration of mechanical ventilation,and length of ICU stay were recorded.Results:After 3 days of treatment,partial pressure of carbon dioxide(PaCO_(2)),peak inspiratory pressure(PIP),airway resistance(Raw),work of breathing(WOB),monocyte distribution width(MDW),neutrophil to lymphocyte ratio(NLR),procalcitonin(PCT),brain natriuretic peptide(BNP)and the incidence of adverse reactions in NIPPV group were significantly lower than those in HFNC group(P<0.05).The duration of mechanical ventilation and length of hospital stay were shorter than those in the HFNC group(P<0.05).Blood oxygen saturation(SaO_(2)),partial pressure of oxygen(PaO_(2)),oxygenation index(OI),forced vital capacity(FVC),peak expiratory flow rate(PEF),forced expiratory volume in one second(FEV1)and forced expiratory volume in the first second predicted(FEV1%pred)in NIPPV group were higher than those in HFNC group(P<0.05).Conclusion:Compared with HFNC oxygen therapy,applying alternating therapy with NIPPV and HFNC in first aid of patients with severe acute respiratory failure can significantly improve blood gas indexes and pneodynamics indexes,help with pulmonary function recovery,alleviate inflammation and myocardial injury,reduce the occurrence of adverse events,and improve the prognosis.
作者
丰毅
刘南枝
王婷花
Feng Yi;Liu Nan-zhi;Wang Ting-hua(Department of Intensive Care Medicine,The People's Hospital of Poyang,Shangrao 333100,Jiangxi,China)
基金
上饶市指导性科技计划(编号:2023CZDX113)。
关键词
NIPPV
HFNC
交替疗法
急重症呼吸衰竭
Non-invasive positive pressure ventilation
High-flow nasal cannula
Alternating therapy
Severe acute respiratory failure
作者简介
丰毅,男,副主任医师,主要从事重症医学科工作,Email:15070302662@163.com。
