作者：鲍洁，申改玲，乔庆哲，贺向红

单位：

050000 河北省石家庄市，河北省胸科医院呼吸科

Units：

Department of Respiration，Hebei Chest Hospital，Shijiazhuang 050000，China

关键词：

哮喘；呼吸功能不全；成年人；经鼻高流量氧疗；疗效比较研究

Keywords：

Asthma；Respiratory insufficiency；Adult；High-flow nasal cannula；Comparative effectiveness research

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.025

Funds：

河北省医学科学研究重点课题（20180658）

摘要：

背景　支气管哮喘（BA）是呼吸科常见病，BA 急性发作并呼吸衰竭患者病情危重，而良好的呼吸支持在患者救治中可发挥重要作用。目的　比较经鼻高流量氧疗（HFNC）与传统经鼻导管吸氧治疗成年 BA 急性发作并Ⅰ型呼吸衰竭的疗效。方法　选取 2017 年 12 月—2018 年 12 月在河北省胸科医院呼吸科住院的 BA 急性发作并Ⅰ型呼吸衰竭患者 160 例为研究对象。采用随机数字表法将患者分为对照组和观察组，各 80 例。对照组患者在常规治疗基础上进行传统经鼻导管吸氧，观察组患者在常规治疗基础上进行 HFNC。比较两组临床疗效，治疗前和治疗 1 h 后心电监护指标〔包括呼吸频率（RR）、心率（HR）、血氧饱和度（SpO2 ）〕、血气分析指标〔包括 pH 值、动脉血氧分压（PaO2 ）、动脉血二氧化碳分压（PaCO2 ）〕，住院时间、住院费用、插管率、不良事件发生情况。结果　观察组临床疗效优于对照组（P ＜ 0.05）。观察组治疗后 RR、HR 低于对照组，SpO2 高于对照组（P ＜ 0.05）。对照组、观察组治疗后 RR、HR 分别低于本组治疗前，SpO2 分别高于本组治疗前（P ＜ 0.05）。观察组治疗后 pH 值、PaO2 高于对照组（P ＜ 0.05）。对照组、观察组治疗后 pH 值、PaO2 分别高于本组治疗前（P ＜ 0.05）。观察组住院时间短于对照组，住院费用、插管率低于对照组（P ＜ 0.05）。观察组不良事件发生率低于对照组（P ＜ 0.05）。结论　与传统经鼻导管吸氧相比，HFNC 可以更好地改善成年 BA 急性发作并Ⅰ型呼吸衰竭患者的缺氧状态，缩短住院时间，降低住院费用及插管率，且安全性好，值得临床推广应用。

Abstract：

Background　Bronchial asthma（BA）is a common disease in the Department of Respiration，and patients with acute attack of BA and respiratory failure are in critical condition，thus good respiratory support plays an important role in the treatment of patients.Objective　To compare the efficacy of high-flow nasal cannula（HFNC）and traditional transnasal catheter oxygen inhalation on adult acute attack of BA with type Ⅰ respiratory failure.Methods　From December 2017 to December 2018，160 patients with acute attack of BA and type Ⅰ respiratory failure who were hospitalized in Department of Respiration of Hebei Chest Hospital were enrolled as the research subjects，and they were divided into control group and observation group according to random number table method，with 80 cases in each group.Patients in control group received traditional transnasal catheter oxygen therapy on the basis of conventional treatment，and patients in observation group receivedHFNC on the basis of conventional treatment.The clinical curative effect，electrocardiogram monitoring indexes〔respiratory rate（RR），heart rate（HR），blood oxygen saturation（SpO 2 ）〕and blood gas analysis indicators〔pH value，partial pressure of oxygen（PaO 2 ），partial pressure of carbon dioxide（PaCO 2 ）〕before treatment and 1 h after treatment，hospitalization time，hospitalization cost，intubation rate and occurrence of adverse reactions were compared between the two groups.Results　The clinical curative effect in observation group was better than that in control group（P ＜ 0.05）.After treatment，RR and HR in observation group were lower than those in control group，while SpO 2 was higher than that in control group（P ＜ 0.05）.RR and HR after treatment in control group and observation group were lower than those before treatment，while SpO 2 was higher than that before treatment，respectively（P ＜ 0.05）.The pH value and PaO 2 in observation group after treatment were higher than those in control group（P ＜ 0.05）.The pH value and PaO 2 in control group and observation group after treatment were higher than those before treatment，respectively（P ＜ 0.05）.The hospitalization time in observation group was shorter than that in control group，and the hospitalization cost and intubation rate were lower than those in control group （P ＜ 0.05）.The incidence rates of adverse events in observation group were lower than those in control group（P ＜ 0.05）.Conclusion　Compared with traditional transnasal catheter oxygen inhalation，HFNC can better improve the hypoxic state of adult acute attack of BA patients with type Ⅰ respiratory failure，shorten the hospitalization time，reduce the hospitalization cost and intubation rate，and has good safety，which is worthy of clinical application.

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