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经鼻高流量氧疗与无创机械通气治疗创伤相关肺损伤的疗效比较

High-flow nasal oxygen therapy versus non-invasive mechanical ventilation in treatment of patients with trauma-associated acute lung injury

    摘要
  • 摘要:
      目的  比较经鼻高流量氧疗(HFNO)与无创机械通气(NIV)治疗创伤相关肺损伤的疗效。
      方法  将43例外伤合并急性肺损伤(ALI)患者随机分为HFNO组20例与NIV组23例，比较2组治疗前(0 min)及治疗60、120 min的呼吸参数呼吸频率(RR)、动脉血氧分压p(O2)、氧合指数p(O2)/FiO2、循环参数心率、平均动脉压(MAP)、乳酸。研究结束时，采用视觉模拟评分法评估患者呼吸困难感、不舒适感及口渴感。
      结果  与0 min相比，2组通气60、120 min的RR显著降低, p(O2)、p(O2)/FiO2显著升高(P < 0.05), 但循环参数(心率、MAP、乳酸)的差异无统计学意义(P>0.05); 与60 min相比, 2组通气120 min的呼吸及循环参数无显著变化(P>0.05)。2组患者通气60、120 min的RR、p(O2)、p(O2)/FiO2、心率、MAP、乳酸比较，差异均无统计学意义(P>0.05)。HFNO组患者呼吸困难感、不舒适感、口渴感评分低于NIV组，差异有统计学意义(P < 0.05)。
      结论  HFNO与NIV都可以在短时间内改善创伤相关ALI患者的氧合情况，但HFNO具有更好的舒适性，可以作为NIV不耐受患者的替代治疗手段。

     

    Abstract:
      Objective  To compare the efficacy of high-flow nasal oxygen (HFNO) therapy and non-invasive ventilation (NIV) therapy in treatment of patients with trauma-associated acute lung injury.
      Methods  Totally 43 trauma patients with acute lung injury (ALI) were randomly divided into HFNO group (n=20) and NIV group (n=23). The respiratory parameters respiratory rate (RR), partial pressure of arterial oxygen p(O2), oxygenation index p(O2)/FiO2 and circulation parameters heart rate, mean arterial pressure (MAP), lactate before treatment (0 min) and after treatment (60 and 120 min) were compared. At the end of the study, the patients' dyspnea, discomfort and thirst were assessed by visual analogue score.
      Results  Compared with indexes at 0 min, RR at 60 and 120 min decreased significantly in both groups, p(O2), p(O2)/FiO2 increased significantly (P < 0.05), but there were no significant differences in circulatory parameters (heart rate, MAP, lactate) (P>0.05). Compared with indexes at 60 min, there was no significant change in respiratory and circulatory parameters at 120 min between the two groups (P>0.05). There were no significant differences in RR, p(O2), p(O2)/FiO2, heart rate, MAP and lactate between the two groups (P>0.05). The scores of dyspnea, discomfort and thirst in HFNO group were significantly lower than those in NIV group (P < 0.05).
      Conclusion  Both HFNO and NIV can improve oxygenation of ALI patients in a short time, but HFNO is more comfort, and it can be used as an alternative treatment for patients with NIV intolerance.

     

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