重症肺炎合并Ⅰ型呼吸衰竭经鼻高流量湿化氧疗临床效果评价_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 刘仁杰 , 常双喜 , 李宝珠 , 张雪姣 , 宋伟伟

郑州市第一人民医院呼吸与危重症医学科（河南郑州 450004）;

Corresponding author：

刘仁杰, Email: liurenjie2010@126.com

Keywords：

重症肺炎; Ⅰ型呼吸衰竭; 经鼻高流量湿化氧疗; 无创正压通气; 文丘里面罩吸氧.

DOI：

10.7507/1671-6205.202004057

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目的对比文丘里面罩吸氧及无创正压通气（NPPV），评价经鼻高流量湿化氧疗（HFNC）在重症肺炎Ⅰ型呼吸衰竭患者中应用效果。方法选择 2017 年 3 月至 2019 年 12 月我院呼吸与危重症医学科重症肺炎合并Ⅰ型呼吸衰竭经文丘里面罩吸氧、HFNC 及 NPPV 治疗患者 142 例。随机数字表法分为文丘里面罩吸氧组为面罩组 46 例，HFNC 组 49 例，NPPV 组 47 例，分别比较治疗后 2 h 三组患者 SpO₂、PaO₂、PaO₂/FiO₂、PaCO₂、pH、RR、HR、舒适度、耐受性程度、鼻腔干燥程度、咽喉干燥程度、咳痰难易程度、气管插管率。结果 HFNC 组与面罩组间 SpO₂、PaO₂、PaO₂/FiO₂ 差异有统计学意义（均 P<0.05），HFNC 组与 NPPV 组间SpO₂差异无统计学意义（P>0.05）；HFNC 组与 NPPV 组间 PaO₂、PaO₂/FiO₂ 差异有统计学意义（均 P<0.05）；三组间 PaCO₂、pH、RR、HR 差异无统计学意义（P>0.05）。HFNC 组与 NPPV 组间舒适度、耐受性、鼻腔干燥程度、咽喉干燥程度、咳痰难易程差异有统计学意义（P<0.05）；HFNC 组与面罩组鼻腔黏膜干燥程度、咳痰难易程度、气管插管差异有统计学意义（均 P<0.05），NPPV 组与面罩组间气管插管差异有统计学意义（P<0.05）；HFNC 组与 NPPV 组间气管插管差异无统计学意义（P>0.05）。结论 HFNC 可应用于重症肺炎Ⅰ型呼吸衰竭早期呼吸支持治疗，患者依从性好，不良反应少，临床治疗效果肯定，值得在临床推广。

Citation： 刘仁杰, 常双喜, 李宝珠, 张雪姣, 宋伟伟. 重症肺炎合并Ⅰ型呼吸衰竭经鼻高流量湿化氧疗临床效果评价. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(9): 656-660. doi: 10.7507/1671-6205.202004057 Copy

1.	Esteban A, Frutos-Vivar F, Muriel A, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med, 2013, 188(2): 220-230.
2.	Kallstrom TJ. AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility-2002 revision & update. Respir Care, 2002, 47(6): 717-720.
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6.	Sztrymf B, Messika J, Bertrand F, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med, 2011, 37(11): 1780-1786.
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8.	Lee CC, Mankodi D, Shaharyar S, et al. High flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation in adults with acute hypoxemic respiratory failure: A systematic review. Respir Med, 2016, 121: 100-108.
9.	中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识. 中华结核和呼吸杂志, 2019, 42(2): 83-91.
10.	Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care, 2015, 3(1): 15.
11.	Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth, 2009, 103(6): 886-890.
12.	Sotello D, Orellana-Barrios M, Rivas AM, et al. High flow nasal cannulas for oxygenation: an audit of its use in a tertiary care hospital. Am J Med Sci, 2015, 350(4): 308-312.
13.	Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med, 2015, 372(23): 2185-2196.
14.	Stéphan F, Barrucand B, Petit P, et al. High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: a randomized clinical trial. JAMA, 2015, 313(23): 2331-2339.
15.	Monro-Somerville T, Sim M, Ruddy J, et al. The effect of high-flow nasal cannula oxygen therapy on mortality and intubation rate in acute respiratory failure: a systematic review and meta-analysis. Crit Care Med, 2017, 45(4): e449-e456.
16.	Corley A, Rickard CM, Aitken LM, et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database Syst Rev, 2017, 5(5): D10172.
17.	Nedel WL, Deutschendorf C, Moraes RFE. High-flow nasal cannula in critically ill subjects with or at risk for respiratory failure: a systematic review and meta-analysis. Respir Care, 2017, 62(1): 123-132.
18.	Sztrymf B, Messika J, Mayot T, et al. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care, 2012, 27(3): 324-329.
19.	Roca O, Riera J, Torres F, et al. High-flow oxygen therapy in acute respiratory failure. Respir Care, 2010, 55(4): 408-413.
20.	Ni YN, Luo J, Yu H, et al. Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation?: a systematic review and meta-analysis. Chest, 2017, 151(4): 764-775.
21.	Messika J, Ben AK, Gaudry S, et al. Use of high-flow nasal cannula oxygen therapy in subjects with ards: a 1-year observational study. Respir Care, 2015, 60(2): 162-169.
22.	岳伟岗, 张志刚, 张彩云, 等. 经鼻高流量氧疗对呼吸衰竭患者疗效的 Meta 分析. 中华危重病急救医学, 2017, 29(5): 396-402.
23.	简佳庆, 段凤英, 肖远超, 等. ICU 拔除气管插管患者使用经鼻高流量湿化氧疗对比传统氧疗或无创正压通气临床疗效的 Meta 分析. 中国呼吸与危重监护杂志, 2019, 18(1): 42-50.
24.	Chanques G, Constantin JM, Sauter M, et al. Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Intensive Care Med, 2009, 35(6): 996-1003.
25.	Hernández G, Roca O, Colinas L. High-flow nasal cannula support therapy: new insights and improving performance. Crit Care, 2017, 21(1): 62.
26.	Spoletini G, Alotaibi M, Blasi F, et al. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest, 2015, 148(1): 253-261.
27.	Randerath WJ, Meier J, Genger H, et al. Efficiency of cold passover and heated humidification under continuous positive airway pressure. Eur Respir J, 2002, 20(1): 183-186.
28.	张飞鹏, 田园园, 郭秀荣. 经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重的研究现状. 安徽医学, 2016, 37(5): 642-644.
29.	曹萌. 经鼻高流量湿化氧疗在 NICU 急性低氧性呼吸功能衰竭患者中的应用. 中国急救复苏与灾害医学杂志, 2016, 11(8): 822-823.
30.	罗裕锋, 瞿嵘, 凌云, 等. 中国首例输入性中东呼吸综合征患者经鼻高流量氧疗的效果观察. 中华危重病急救医学, 2015, 27(10): 841-844.

1. Esteban A, Frutos-Vivar F, Muriel A, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med, 2013, 188(2): 220-230.
2. Kallstrom TJ. AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility-2002 revision & update. Respir Care, 2002, 47(6): 717-720.
3. Thille AW, Contou D, Fragnoli C, et al. Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors. Crit Care, 2013, 17(6): R269.
4. Schettino G, Altobelli N, Kacmarek RM. Noninvasive positive-pressure ventilation in acute respiratory failure outside clinical trials: experience at the Massachusetts General Hospital. Crit Care Med, 2008, 36(2): 441-447.
5. Schreiber A, DI Marco F, Braido F, et al. High flow nasal cannula oxygen therapy, work in progress in respiratory critical care. Minerva Med, 2016, 107(6Suppl1): 14-20.
6. Sztrymf B, Messika J, Bertrand F, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med, 2011, 37(11): 1780-1786.
7. Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med, 2017, 195(9): 1207-1215.
8. Lee CC, Mankodi D, Shaharyar S, et al. High flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation in adults with acute hypoxemic respiratory failure: A systematic review. Respir Med, 2016, 121: 100-108.
9. 中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识. 中华结核和呼吸杂志, 2019, 42(2): 83-91.
10. Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care, 2015, 3(1): 15.
11. Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth, 2009, 103(6): 886-890.
12. Sotello D, Orellana-Barrios M, Rivas AM, et al. High flow nasal cannulas for oxygenation: an audit of its use in a tertiary care hospital. Am J Med Sci, 2015, 350(4): 308-312.
13. Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med, 2015, 372(23): 2185-2196.
14. Stéphan F, Barrucand B, Petit P, et al. High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: a randomized clinical trial. JAMA, 2015, 313(23): 2331-2339.
15. Monro-Somerville T, Sim M, Ruddy J, et al. The effect of high-flow nasal cannula oxygen therapy on mortality and intubation rate in acute respiratory failure: a systematic review and meta-analysis. Crit Care Med, 2017, 45(4): e449-e456.
16. Corley A, Rickard CM, Aitken LM, et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database Syst Rev, 2017, 5(5): D10172.
17. Nedel WL, Deutschendorf C, Moraes RFE. High-flow nasal cannula in critically ill subjects with or at risk for respiratory failure: a systematic review and meta-analysis. Respir Care, 2017, 62(1): 123-132.
18. Sztrymf B, Messika J, Mayot T, et al. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care, 2012, 27(3): 324-329.
19. Roca O, Riera J, Torres F, et al. High-flow oxygen therapy in acute respiratory failure. Respir Care, 2010, 55(4): 408-413.
20. Ni YN, Luo J, Yu H, et al. Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation?: a systematic review and meta-analysis. Chest, 2017, 151(4): 764-775.
21. Messika J, Ben AK, Gaudry S, et al. Use of high-flow nasal cannula oxygen therapy in subjects with ards: a 1-year observational study. Respir Care, 2015, 60(2): 162-169.
22. 岳伟岗, 张志刚, 张彩云, 等. 经鼻高流量氧疗对呼吸衰竭患者疗效的 Meta 分析. 中华危重病急救医学, 2017, 29(5): 396-402.
23. 简佳庆, 段凤英, 肖远超, 等. ICU 拔除气管插管患者使用经鼻高流量湿化氧疗对比传统氧疗或无创正压通气临床疗效的 Meta 分析. 中国呼吸与危重监护杂志, 2019, 18(1): 42-50.
24. Chanques G, Constantin JM, Sauter M, et al. Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Intensive Care Med, 2009, 35(6): 996-1003.
25. Hernández G, Roca O, Colinas L. High-flow nasal cannula support therapy: new insights and improving performance. Crit Care, 2017, 21(1): 62.
26. Spoletini G, Alotaibi M, Blasi F, et al. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest, 2015, 148(1): 253-261.
27. Randerath WJ, Meier J, Genger H, et al. Efficiency of cold passover and heated humidification under continuous positive airway pressure. Eur Respir J, 2002, 20(1): 183-186.
28. 张飞鹏, 田园园, 郭秀荣. 经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重的研究现状. 安徽医学, 2016, 37(5): 642-644.
29. 曹萌. 经鼻高流量湿化氧疗在 NICU 急性低氧性呼吸功能衰竭患者中的应用. 中国急救复苏与灾害医学杂志, 2016, 11(8): 822-823.
30. 罗裕锋, 瞿嵘, 凌云, 等. 中国首例输入性中东呼吸综合征患者经鼻高流量氧疗的效果观察. 中华危重病急救医学, 2015, 27(10): 841-844.

Chinese Journal of Respiratory and Critical Care Medicine

重症肺炎合并Ⅰ型呼吸衰竭经鼻高流量湿化氧疗临床效果评价

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