作者：乔力，钱露露，曹阳洋，徐鹏，刘恒均，刘瑶

单位：

210008 江苏省南京市，南京大学医学院附属鼓楼医院急诊医学科

Units：

Department of Emergency，The Affiliated Hosptial of Nanjing University Medical School Nanjing Drum Tower Hospital，Nanjing 210008，China

关键词：

卒中；缺血性脑卒中；呼吸衰竭；经鼻高流量氧疗；疗效比较研究

Keywords：

Stroke；Ischemic stroke；Respiratory failure；High-flow nasal cannula；Comparative effectiveness research

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.014

Funds：

南京市医学重点科技发展项目（ZKX18013）；南京市医学科技发展一般项目（YKK19065）

摘要：

背景　经鼻高流量氧疗（HFNC）是一种新型无创氧疗方式，能提供恒温、恒湿和高流量的气流，对Ⅰ型呼吸衰竭具有良好的治疗效果，但其在急性缺血性脑卒中（AIS）并Ⅰ型呼吸衰竭患者中的应用效果尚不明确。目的　比较 HFNC 与常规氧疗辅助治疗 AIS 并Ⅰ型呼吸衰竭患者的临床疗效。方法　选取 2017 年 8 月—2019 年 3 月南京大学医学院附属鼓楼医院急诊病房和急诊重症监护室（EICU）收治的 AIS 并Ⅰ型呼吸衰竭患者 98 例，采用随机数字表法分为常规氧疗组（n=48）和 HFNC 组（n=50）。常规氧疗组患者经普通氧气湿化装置行经鼻 / 面罩吸氧，HFNC 组采用费雪派克呼吸湿化治疗仪行 HFNC。比较两组患者氧疗前及氧疗后 2、12、24 h 呼吸频率（RR）、心率（HR）及血气分析指标〔包括 pH 值、动脉血氧分压（PaO 2 ）、动脉血二氧化碳分压（PaCO 2 ）、血乳酸（Lac）及氧合指数〕，氧疗前及氧疗 24 h 痰液黏稠分度，EICU 住院时间、3 d 内气管插管率及 90 d 内病死率。结果　时间与方法在RR、pH值、Lac、氧合指数上无交互作用（P＞0.05）；时间与方法在HR、PaO 2 、PaCO 2 上存在交互作用（P＜0.05）。时间在 RR、HR、pH 值、PaO 2 、PaCO 2 、Lac、氧合指数上主效应显著（P ＜ 0.05）。方法在 RR、HR、PaO 2 、PaCO 2上主效应显著（P ＜ 0.05）；方法在 pH 值、Lac、氧合指数上主效应不显著（P ＞ 0.05）。氧疗 2、12、24 h，HFNC组患者 RR 和 HR 低于常规氧疗组，PaO 2 和氧合指数高于常规氧疗组（P ＜ 0.05）。氧疗 24 h HFNC 组患者痰液黏稠分度优于常规氧疗组（P ＜ 0.05）。HFNC 组患者 EICU 住院时间短于常规氧疗组，3 d 内气管插管率低于常规氧疗组（P＜0.05）。结论　与常规氧疗相比，采用HFNC纠正AIS并Ⅰ型呼吸衰竭患者缺氧效果更优，可减轻患者气道干燥程度，缩短 EICU 住院时间，并降低 3 d 内气管插管率。

Abstract：

Background　High-flow nasal cannula（HFNC） is a new type of non-invasive oxygen therapy，which can provide constant temperature，humidity and high flow of air，it has a good therapeutic effect on treating type Ⅰ respiratoryfailure，but its application effect on patients with acute ischemic stroke（AIS） and type Ⅰ respiratory failure is unclear. Objective　To compare the therapeutic effect of HFNC and conventional oxygen therapy in the adjuvant trerapy of AIS patients complicated with type Ⅰ respiratory failure.Methods　From August 2017 to March 2019，a total of 98 AIS patients complicated with type Ⅰ respiratory failure in the Emergency Ward and Emergency Intensive Care Unit（EICU） of the Affiliated Hosptial of Nanjing University Medical School Nanjing Drum Tower Hospital were selected，and they were randomly divided into conventional oxygen therapy group（n=48） and HFNC group（n=50）.The patients in the conventional oxygen therapy group were treated with nasal/mask oxygen inhalation by ordinary oxygen humidification device，and the patients in the HFNC group were treated with HFNC by Fisher Parker respiratory humidification treatment instrument.Respiratory rate（RR），heart rate（HR） and blood gas analysis indexes〔including pH value，arterial partial pressure of oxygen（PaO 2 ），arterial partial pressure ofcarbon dioxide（PaCO 2 ），blood lactic acid（Lac）and oxygenation index〕 were compared between the two groups before oxygen therapy and 2，12 and 24 hours after oxygen therapy，the classification of sputum viscosity，hospitalization time in EICU，endotracheal intubation rate within 3 days and mortality within 90 days were analyzed.Results　There was no statistically significant interaction in RR，pH value，Lac and oxygenation index between time and method，respectively（P ＞ 0.05）.There was statistically significant interaction in HR，PaO 2 and PaCO 2 between time and method，respectively（P ＜ 0.05）. Main effects of time was statistically significant in RR，HR，pH value，PaO 2 ，PaCO 2 ，Lac and oxygenation index（P ＜ 0.05）.Main effects of method was statistically significant in RR，HR，PaO 2 and PaCO 2 （P ＜ 0.05）；main effects of method was no statistically significant in pH value，Lac and oxygenation index（P ＞ 0.05）.2，12 and 24 hours after oxygen therapy，RR and HR of HFNC group were lower than those of conventional oxygen therapy group，PaO 2 and oxygenation index were higher than those of conventional oxygen therapy group（P ＜ 0.05）.24 hours after oxygen therapy，the classification of sputum viscosity of HFNC group was better than that of conventional oxygen therapy group（P ＜ 0.05）.The hospitalization time in EICU of HFNC group was shorter than that of conventional oxygen therapy group，and the intubation rate within 3 days was lower than that of conventional oxygen therapy group（P ＜ 0.05）.Conclusion　Compared with conventional oxygen therapy，HFNC is more effective in correcting hypoxia of AIS patients with type Ⅰ respiratory failure，and can reduce the degree of airway dryness，shorten the hospitalization time in EICU，reduce the endotracheal intubation rate within 3 days.

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