重癥肺炎合并Ⅰ型呼吸衰竭經鼻高流量濕化氧療臨床效果評價_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 劉仁杰 , 常雙喜 , 李寶珠 , 張雪姣 , 宋偉偉

鄭州市第一人民醫院呼吸與危重癥醫學科（河南鄭州 ?450004）;

Corresponding?author：

劉仁杰, Email: liurenjie2010@126.com

Keywords：

重癥肺炎; Ⅰ型呼吸衰竭; 經鼻高流量濕化氧療; 無創正壓通氣; 文丘里面罩吸氧.

DOI：

10.7507/1671-6205.202004057

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目的對比文丘里面罩吸氧及無創正壓通氣（NPPV），評價經鼻高流量濕化氧療（HFNC）在重癥肺炎Ⅰ型呼吸衰竭患者中應用效果。方法選擇 2017 年 3 月至 2019 年 12 月我院呼吸與危重癥醫學科重癥肺炎合并Ⅰ型呼吸衰竭經文丘里面罩吸氧、HFNC 及 NPPV 治療患者 142 例。隨機數字表法分為文丘里面罩吸氧組為面罩組 46 例，HFNC 組 49 例，NPPV 組 47 例，分別比較治療后 2 h 三組患者 SpO₂、PaO₂、PaO₂/FiO₂、PaCO₂、pH、RR、HR、舒適度、耐受性程度、鼻腔干燥程度、咽喉干燥程度、咳痰難易程度、氣管插管率。結果 HFNC 組與面罩組間 SpO₂、PaO₂、PaO₂/FiO₂ 差異有統計學意義（均 P<0.05），HFNC 組與 NPPV 組間SpO₂差異無統計學意義（P>0.05）；HFNC 組與 NPPV 組間 PaO₂、PaO₂/FiO₂ 差異有統計學意義（均 P<0.05）；三組間 PaCO₂、pH、RR、HR 差異無統計學意義（P>0.05）。HFNC 組與 NPPV 組間舒適度、耐受性、鼻腔干燥程度、咽喉干燥程度、咳痰難易程差異有統計學意義（P<0.05）；HFNC 組與面罩組鼻腔黏膜干燥程度、咳痰難易程度、氣管插管差異有統計學意義（均 P<0.05），NPPV 組與面罩組間氣管插管差異有統計學意義（P<0.05）；HFNC 組與 NPPV 組間氣管插管差異無統計學意義（P>0.05）。結論 HFNC 可應用于重癥肺炎Ⅰ型呼吸衰竭早期呼吸支持治療，患者依從性好，不良反應少，臨床治療效果肯定，值得在臨床推廣。

Citation： 劉仁杰, 常雙喜, 李寶珠, 張雪姣, 宋偉偉. 重癥肺炎合并Ⅰ型呼吸衰竭經鼻高流量濕化氧療臨床效果評價. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(9): 656-660. doi: 10.7507/1671-6205.202004057 Copy

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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.	中華醫學會呼吸病學分會呼吸危重癥醫學學組, 中國醫師協會呼吸醫師分會危重癥醫學工作委員會. 成人經鼻高流量濕化氧療臨床規范應用專家共識. 中華結核和呼吸雜志, 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.	岳偉崗, 張志剛, 張彩云, 等. 經鼻高流量氧療對呼吸衰竭患者療效的 Meta 分析. 中華危重病急救醫學, 2017, 29(5): 396-402.
23.	簡佳慶, 段鳳英, 肖遠超, 等. ICU 拔除氣管插管患者使用經鼻高流量濕化氧療對比傳統氧療或無創正壓通氣臨床療效的 Meta 分析. 中國呼吸與危重監護雜志, 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.	張飛鵬, 田園園, 郭秀榮. 經鼻高流量濕化氧療治療慢性阻塞性肺疾病急性加重的研究現狀. 安徽醫學, 2016, 37(5): 642-644.
29.	曹萌. 經鼻高流量濕化氧療在 NICU 急性低氧性呼吸功能衰竭患者中的應用. 中國急救復蘇與災害醫學雜志, 2016, 11(8): 822-823.
30.	羅裕鋒, 瞿嶸, 凌云, 等. 中國首例輸入性中東呼吸綜合征患者經鼻高流量氧療的效果觀察. 中華危重病急救醫學, 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. 中華醫學會呼吸病學分會呼吸危重癥醫學學組, 中國醫師協會呼吸醫師分會危重癥醫學工作委員會. 成人經鼻高流量濕化氧療臨床規范應用專家共識. 中華結核和呼吸雜志, 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. 岳偉崗, 張志剛, 張彩云, 等. 經鼻高流量氧療對呼吸衰竭患者療效的 Meta 分析. 中華危重病急救醫學, 2017, 29(5): 396-402.
23. 簡佳慶, 段鳳英, 肖遠超, 等. ICU 拔除氣管插管患者使用經鼻高流量濕化氧療對比傳統氧療或無創正壓通氣臨床療效的 Meta 分析. 中國呼吸與危重監護雜志, 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. 張飛鵬, 田園園, 郭秀榮. 經鼻高流量濕化氧療治療慢性阻塞性肺疾病急性加重的研究現狀. 安徽醫學, 2016, 37(5): 642-644.
29. 曹萌. 經鼻高流量濕化氧療在 NICU 急性低氧性呼吸功能衰竭患者中的應用. 中國急救復蘇與災害醫學雜志, 2016, 11(8): 822-823.
30. 羅裕鋒, 瞿嶸, 凌云, 等. 中國首例輸入性中東呼吸綜合征患者經鼻高流量氧療的效果觀察. 中華危重病急救醫學, 2015, 27(10): 841-844.

Chinese Journal of Respiratory and Critical Care Medicine

重癥肺炎合并Ⅰ型呼吸衰竭經鼻高流量濕化氧療臨床效果評價

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